WEBVTT

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You're listening to the PT Pinecast,

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where smart people in healthcare come to

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make noise.

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Here's your host, Jimmy McKay.

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All right.

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Do you want to say thanks to some

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people supporting the show?

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Episode supported by Empower EMR,

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the EMR built by PTs for PTs.

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The tools, the workflows, all the things,

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all the things.

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But in one thing, empoweremr.com,

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if the thing that you touch,

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unfortunately, most,

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if you're a clinician, is the EMR,

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even more than patients, most likely,

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that thing should not be a friction point.

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Kick the tires,

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they'll walk you right through it and show

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you how it could empower your practice.

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See what they did there with the name?

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Empoweremr.com, it's empoweremr.com.

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Our guest today, excited,

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doesn't like the status quo, never has.

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If you're listening, you probably agree.

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This guy's questioned everything from how

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PTs diagnose foot and ankle issues to how

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clinics get paid to whether physical

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therapists should even accept hourly

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wages.

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Ooh, I like that.

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Sounds spicy.

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He's built one of Virginia's most

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respected multi-site clinics,

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founded a nonprofit to protect private

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practices,

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and even launched a payment model that

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bypasses insurance entirely.

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He's got strong opinions, stronger coffee,

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and he's not afraid to challenge the

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system.

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Please welcome Dr. Josh Bailey.

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Welcome to the show, sir.

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How was that intro?

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That was awesome.

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I hope I can live up to that.

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Holy smoke.

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Well, hey, appreciate the time.

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You live in Virginia.

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That's where I went to PT school.

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So that was like a second home to

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me.

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So I sort of miss... I missed it,

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right?

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Like, it's just a good... I don't know.

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I liked it.

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It was... To me, it was...

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It's perfectly positioned in the country

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because I'm from New York and I get

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it.

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We're hustling and bustling.

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We don't pay attention to stuff sometimes.

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Agreed.

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Then I moved to South Carolina and I

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was like, oh, it's way too slow here.

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But I came to like that.

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I got accustomed to it.

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And then I went to PT school in

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Virginia and I was like, ooh,

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I kind of like this.

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This was the Goldilocks for me.

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What do you love about Virginia?

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Well, I'm from Virginia.

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You know, I mean,

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even when I left to go to college,

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I just went to a different part of

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Virginia.

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So, you know, I mean,

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it's four great seasons.

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You know, they're very distinct,

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but I can play golf in all of

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them, you know.

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You can play golf whenever you want.

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It's just how cold or how wet do

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you want to be?

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Right.

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And it never gets too cold or we

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usually don't get too much snow.

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Yeah.

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All right.

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Well,

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we got some spicy things to get into.

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I'm going to ask you a question and

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kick it off.

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What's wrong with how most PTs get paid?

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And if you had that magic wand,

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what would you just go ahead and change

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about it?

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Well, way to kick it off.

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I just have a real beef with PTs

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being doctorally trained,

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but not always acting like doctors.

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And every doctor of substance that you

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know has a base pay

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and then a productivity standard that

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they're trying,

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not that they're shamed of,

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that they're aiming for.

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Because it's aligned right, I'm guessing.

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Correct.

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And you do good care and probably a

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lot of good care,

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then you make more money.

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And I just feel like physical therapy,

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I've been around a long time,

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But I feel like we're kind of moving

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to the fast food version of health care,

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you know, and trading.

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I'm going to trade, you know,

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sixty dollars an hour for an hour of

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my time.

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And and, you know,

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and I'm going to do six hours or

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seven hours or eight hours or whatever it

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is.

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And then I walk away and I'm not

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a doctor at the end of that.

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And every other doctor I'm friends with a

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lot of different types of doctors and they

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all live and breathe what they do.

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And, um,

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and I think there are some PTs that

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do that,

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but I think there's a lot of PTs

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that don't.

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Um, and I,

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and it makes me worried for the longevity

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of our profession.

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So if you could change it,

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what would it, what would the,

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what would the perfect look like or the

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better look like?

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And then how do we go from,

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this is a very PT question,

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or how do we go from where you

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are to that?

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It doesn't need to be perfect,

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but how do we skate towards what you're

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the picture you're drawing?

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I think the first step is there needs

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to be at least some reasonable

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standardization in your market,

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whatever your market is, of starting pay.

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But that's not what you're expected to

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make.

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That's just the guaranteed money.

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That's your baseline.

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Hopefully,

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really motivated PTs don't care about a

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baseline.

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The baseline is you're just telling me

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you know,

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that I need to target above that number,

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whatever it is.

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And then you go do great things and

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you take care of people and you build

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for what you do.

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Right.

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Nothing that you didn't do,

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but build for everything that you do.

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And because anything less than that

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devalues what,

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what we do for a living and,

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and create a profit sharing program,

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right?

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Like every business has to make a margin

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or else you can't keep the business going,

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make a,

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make a small margin in the business and

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everything beyond that margins profit

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share.

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And if I were to start my staff,

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all my staff has that available to them.

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But if I were starting over today,

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one of the things that I would do

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if I opened a second practice,

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it would be a, you know,

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a junior partner model,

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like a partnership where if I'm going to

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open a new clinic,

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you buy in ten percent of it,

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twenty percent of it from the word go.

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And each new clinic would have a junior

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partner in it.

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I wish I had done that.

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PTs don't really work like the Dr.

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Blue Sky model, right?

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Where, you know,

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I come into a practice and I spend

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two years proving my worth and then I

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get the trigger partnership.

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And we've tried to make a semblance of

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that.

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We kind of have a succession program that

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allows PTs to grow through it.

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And what would that add to it?

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Does that add...

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I mean, it's skin in the game, right?

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But when that model is in place,

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what do you see?

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What's different about that?

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It's less trading time for money.

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Now we start to get into the specifics,

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right?

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Sure.

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And I think it's less time for money,

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but it's also you're growing in the

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community, right?

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And you're trying to attract other

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providers to come to work with you that

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are like-minded.

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Right.

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Generally,

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when you see a PT leave a practice,

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it's because they wanted to something,

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you know, that they were disgruntled.

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They're looking for something better,

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different.

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I want to do practice a different way.

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Or you hear private practice practitioners

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opening a clinic because I want to run

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it like I wanted to run it.

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Why can't we have a model where all

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those can go inside and and instead of

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people risking their house and their car

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and their marriage?

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because they're working eighty hours a

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week or a hundred hours a week or

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whatever.

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I think there's a way that there's a

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happy medium that we could all do that

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together and grow great physical therapy

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companies without so much risk.

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So the answers to big,

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complicated questions are usually rooted

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in simplicity.

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Is this an us, meaning the PT profession?

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Is this an us thing,

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a mindset thing that we have to change?

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Or is this external,

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we have to force change on a business

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model insurance, something else?

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Is this an us thing or a we

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got to work with them thing?

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I think it's an us thing.

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I think if we all just agreed that,

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you don't get to be a doctor from

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eight to five and you, you know,

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you have to kind of live it,

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breathe it, think it, um, you know,

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you hear in every PT school,

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I've taught in tons of PT schools all

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over the country.

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I never hear any group that doesn't, that,

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that leaves out, um,

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we're lifelong learners.

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Right.

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But then, right.

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But then I, and you know,

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one-on-one and compassion,

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all the things that bring the bile in

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the back of your throat, um,

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Because you know that probably the seventy

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percent can't do all those things.

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Yeah.

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And and usually it's culture.

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The culture around them is what drives

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them to continue to want to grow and

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develop.

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But a lot of people just get stuck.

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And and I think if we get stuck

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to what's my hourly rate versus what do

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I have the capacity to generate?

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Yeah.

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Um,

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it could be different and maybe I'm wrong

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and maybe it's just my motivations are

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different,

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but I've spent every day of my life

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treating life like a sporting event.

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Right.

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Somebody's got to win.

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Somebody's got to lose.

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I don't intend to lose.

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And I mean,

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I was like that in high school.

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You know, I did.

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I never did homework.

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I just sat across the room and like,

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I think I can beat that guy.

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You know, they seem like the smart one.

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You know, and frankly,

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I did it in school.

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It wasn't always the best strategy.

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And I've done it in business, you know,

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and I wasn't trying to beat someone to

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hurt them.

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That's just how I set the bar.

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What's the goal?

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Can I get there better, faster, cheaper?

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Yeah.

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I mean,

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I talked to my team about if we

00:09:48.932 --> 00:09:50.513
all just treated our profession like we

00:09:50.533 --> 00:09:52.634
treat the speed limit, we'd be great.

00:09:53.493 --> 00:09:53.692
Right.

00:09:54.092 --> 00:09:55.754
And, you know, you see the sign five,

00:09:55.774 --> 00:09:56.774
five speed limit,

00:09:57.374 --> 00:09:58.354
but technically you're supposed to be

00:09:58.374 --> 00:09:59.315
running fifty four.

00:10:00.274 --> 00:10:02.096
But if you if you got behind that

00:10:02.135 --> 00:10:03.456
person going fifty four,

00:10:03.936 --> 00:10:05.296
we would all lose our mind.

00:10:05.697 --> 00:10:06.836
You know, like, what are you doing?

00:10:06.956 --> 00:10:07.136
Right.

00:10:07.437 --> 00:10:09.077
Because that was just one of the bottom

00:10:09.138 --> 00:10:09.817
suggestion.

00:10:10.538 --> 00:10:10.738
Right.

00:10:11.238 --> 00:10:13.698
But then you get into an employment arena

00:10:14.318 --> 00:10:15.038
and it's like,

00:10:15.278 --> 00:10:16.559
what are your KPIs or what are your

00:10:16.580 --> 00:10:18.399
baselines or whatever you want to call it?

00:10:19.139 --> 00:10:20.640
And then everybody targets the bar.

00:10:22.222 --> 00:10:23.563
They don't think about what's above the

00:10:23.583 --> 00:10:23.803
bar.

00:10:23.823 --> 00:10:24.884
They just target the bar.

00:10:25.524 --> 00:10:28.005
And subsequently, if life gets in the way,

00:10:28.566 --> 00:10:29.586
they fall below the bar.

00:10:30.267 --> 00:10:31.988
And I see that all the time.

00:10:32.048 --> 00:10:34.229
And when I first became CEO of our

00:10:34.269 --> 00:10:34.749
practice,

00:10:34.889 --> 00:10:35.850
I thought it was something wrong with

00:10:35.870 --> 00:10:36.389
their practice.

00:10:36.409 --> 00:10:37.530
I'm like, we're really good.

00:10:37.951 --> 00:10:38.871
Like, why are we great?

00:10:39.932 --> 00:10:42.513
And is it an aptitude problem?

00:10:42.552 --> 00:10:44.094
Is it an emotional quotient?

00:10:44.394 --> 00:10:45.154
Like, what is it?

00:10:45.735 --> 00:10:47.456
And I couldn't find anything wrong.

00:10:48.227 --> 00:10:49.369
And so I started looking at other

00:10:49.389 --> 00:10:50.669
businesses and I'm like, well,

00:10:50.690 --> 00:10:51.831
they kind of have the same problems that

00:10:51.951 --> 00:10:52.412
we have.

00:10:53.673 --> 00:10:54.634
And then I started looking at some of

00:10:54.653 --> 00:10:56.274
my friends and I'm like, geez,

00:10:56.315 --> 00:10:58.517
can we all move it underachieve here?

00:10:58.677 --> 00:11:01.159
And then I realized the issue was had

00:11:01.279 --> 00:11:03.381
nothing to do with the capacity.

00:11:03.402 --> 00:11:04.523
It had everything to do with what we

00:11:04.543 --> 00:11:05.403
were paying attention to.

00:11:06.303 --> 00:11:07.745
And if we pay attention to the bar,

00:11:08.846 --> 00:11:10.248
then we tend to try to jump over

00:11:10.268 --> 00:11:10.727
that bar.

00:11:10.768 --> 00:11:13.591
And if the bar is put with trouble,

00:11:13.975 --> 00:11:14.495
Yeah, it's funny.

00:11:14.515 --> 00:11:16.297
It's like they teach you...

00:11:16.456 --> 00:11:19.018
I was taught when you ski a little

00:11:19.038 --> 00:11:21.519
bit out of bounds and there's a tree,

00:11:22.418 --> 00:11:23.779
if you say, avoid the tree,

00:11:23.820 --> 00:11:24.980
avoid the tree, avoid the tree,

00:11:25.039 --> 00:11:26.000
guess what you're going to hit.

00:11:26.039 --> 00:11:27.500
But if they say,

00:11:27.740 --> 00:11:29.301
aim at the tree and your goal is

00:11:29.321 --> 00:11:30.442
to aim and then move...

00:11:31.683 --> 00:11:32.445
That's what happens.

00:11:32.745 --> 00:11:33.325
So it's funny.

00:11:33.345 --> 00:11:35.067
It's like when you try to avoid something,

00:11:35.106 --> 00:11:35.966
you wind up hitting it.

00:11:36.447 --> 00:11:37.148
When you try to hit it,

00:11:37.168 --> 00:11:38.149
you wind up avoiding it.

00:11:38.568 --> 00:11:39.289
So the goal is like,

00:11:39.330 --> 00:11:42.312
how do you align those things correctly?

00:11:42.912 --> 00:11:43.993
Who do you listen to?

00:11:45.094 --> 00:11:46.995
You sound like you've read some of the

00:11:47.056 --> 00:11:47.716
similar books.

00:11:48.456 --> 00:11:52.178
Who are the authors or people?

00:11:52.299 --> 00:11:53.721
It doesn't even matter in PT, right?

00:11:53.740 --> 00:11:55.402
Because business is business or leadership

00:11:55.442 --> 00:11:55.922
is leadership.

00:11:55.942 --> 00:11:56.702
Those things translate.

00:11:57.003 --> 00:11:57.864
Who do you look to?

00:11:57.964 --> 00:11:59.024
Who are some of the things on your

00:11:59.044 --> 00:11:59.345
shelf?

00:12:00.631 --> 00:12:01.312
Well, my,

00:12:01.331 --> 00:12:03.714
my favorite book is good to great.

00:12:03.933 --> 00:12:05.115
I was going to say you were dripping

00:12:05.154 --> 00:12:06.014
Collins right there.

00:12:06.355 --> 00:12:07.836
I mean, I, I,

00:12:08.057 --> 00:12:10.618
I can probably quote chapter after chapter

00:12:10.738 --> 00:12:14.441
and I teach some leadership, you know,

00:12:14.480 --> 00:12:15.140
classes that,

00:12:15.942 --> 00:12:17.042
that I use good to great as a

00:12:17.102 --> 00:12:17.363
tool.

00:12:17.822 --> 00:12:18.123
Right.

00:12:18.302 --> 00:12:21.205
And, um, and just that first chapter of,

00:12:21.404 --> 00:12:23.206
you know, level five leadership, like,

00:12:24.206 --> 00:12:26.168
I don't know that I've ever personally met

00:12:26.347 --> 00:12:27.229
a level five leader.

00:12:28.043 --> 00:12:28.923
But, you know,

00:12:28.984 --> 00:12:30.485
it's just like that same lifelong

00:12:30.524 --> 00:12:31.905
learning, you know,

00:12:31.926 --> 00:12:32.846
like that's the target.

00:12:32.905 --> 00:12:34.047
Like I got to go there.

00:12:34.126 --> 00:12:35.246
I got to figure out how I get

00:12:35.667 --> 00:12:37.467
above this level and above the next level

00:12:37.508 --> 00:12:38.208
and above, you know,

00:12:38.288 --> 00:12:40.789
so I can be that enduring leader.

00:12:40.830 --> 00:12:43.650
And I know clearly I haven't achieved it,

00:12:44.932 --> 00:12:46.072
but but I'm still trying.

00:12:46.091 --> 00:12:48.352
And, you know, and I hope I'm trying,

00:12:48.373 --> 00:12:50.374
you know, two days after I'm retired,

00:12:50.634 --> 00:12:52.095
you know, you know,

00:12:52.134 --> 00:12:53.576
because I don't I don't want to quit

00:12:53.676 --> 00:12:53.895
on it.

00:12:54.296 --> 00:12:54.456
Yeah.

00:12:55.216 --> 00:12:58.941
um direct to employer contracting i on

00:12:59.000 --> 00:13:00.562
purpose saw that was going to be a

00:13:00.621 --> 00:13:01.722
topic we were going to talk about i

00:13:01.743 --> 00:13:03.945
on purpose didn't look it up because i

00:13:04.005 --> 00:13:06.207
like to go into certain topics or

00:13:06.227 --> 00:13:08.629
situations where i'm like be the person

00:13:08.649 --> 00:13:10.951
who's confused so what what is it and

00:13:11.052 --> 00:13:13.173
why do you say it's the purest form

00:13:13.654 --> 00:13:17.677
of pt sure so functionally direct to

00:13:17.697 --> 00:13:19.200
employer contracting is

00:13:20.306 --> 00:13:22.547
making a contract directly with the

00:13:22.667 --> 00:13:25.067
primary payer of healthcare services,

00:13:26.707 --> 00:13:28.509
which is historically in America,

00:13:29.349 --> 00:13:30.809
the employer, right?

00:13:31.350 --> 00:13:33.129
The employers buying an insurance plan are

00:13:33.149 --> 00:13:35.711
paying the majority of an expense product

00:13:35.730 --> 00:13:36.692
for an insurance plan.

00:13:38.152 --> 00:13:40.592
And then the employee kicks in some and

00:13:40.692 --> 00:13:42.513
they have an insurance package.

00:13:43.274 --> 00:13:45.173
The problem with that is we have to

00:13:45.214 --> 00:13:47.115
play by all of those rules.

00:13:48.277 --> 00:13:50.918
which have become a huge issue in physical

00:13:50.957 --> 00:13:53.600
therapy, you know, as far as, you know,

00:13:53.759 --> 00:13:55.701
authorization and verification and,

00:13:55.941 --> 00:13:58.101
you know, and then by the way,

00:13:58.221 --> 00:14:00.543
I submitted a clean claim and, you know,

00:14:00.582 --> 00:14:01.383
you hadn't paid it.

00:14:01.543 --> 00:14:03.303
And then I'm tracking it down and all

00:14:03.344 --> 00:14:04.705
those things that have administrative

00:14:04.825 --> 00:14:07.326
burden, they chip away at,

00:14:08.020 --> 00:14:12.166
profit and devalue what we do as providers

00:14:12.886 --> 00:14:15.470
so you know my feeling is the best

00:14:15.830 --> 00:14:17.711
contract is the one that's directly with

00:14:17.731 --> 00:14:21.015
the employer i can make more money my

00:14:21.056 --> 00:14:25.421
providers can make more money my providers

00:14:25.441 --> 00:14:27.102
don't have the administrative burden the

00:14:27.143 --> 00:14:28.504
employer has a discount

00:14:29.448 --> 00:14:32.691
And we actually have PT as the front

00:14:32.831 --> 00:14:34.251
end of musculoskeletal care,

00:14:34.812 --> 00:14:36.953
which is what we've been trying to do

00:14:36.994 --> 00:14:39.115
for the last ten or fifteen years.

00:14:39.135 --> 00:14:40.375
We've been talking about it and talking

00:14:40.395 --> 00:14:40.697
about it,

00:14:40.736 --> 00:14:42.238
but nobody's really getting around to

00:14:42.278 --> 00:14:42.638
doing it.

00:14:43.619 --> 00:14:45.120
And I feel like that's the pathway to

00:14:45.179 --> 00:14:45.259
it.

00:14:45.340 --> 00:14:46.561
And that's why it's the purest form,

00:14:46.900 --> 00:14:47.201
right?

00:14:47.660 --> 00:14:48.201
It's easy.

00:14:49.101 --> 00:14:50.222
Most of our contracts,

00:14:50.243 --> 00:14:52.644
the patients have no payment or very,

00:14:52.664 --> 00:14:53.725
very low copayment.

00:14:53.885 --> 00:14:54.745
And when I say low,

00:14:54.806 --> 00:14:55.966
I'm talking ten dollars.

00:14:57.769 --> 00:14:59.129
is what a patient might pay.

00:14:59.470 --> 00:15:00.269
In some contracts,

00:15:00.309 --> 00:15:01.250
the patient pays nothing.

00:15:02.532 --> 00:15:04.212
And the employer has recognized,

00:15:04.933 --> 00:15:07.775
I can reduce all the downstream expenses

00:15:07.875 --> 00:15:10.317
of unnecessary tests, medications,

00:15:10.418 --> 00:15:10.977
surgeries.

00:15:10.998 --> 00:15:15.481
And you don't even have to be great.

00:15:16.162 --> 00:15:18.344
If you're just a reasonably good physical

00:15:18.364 --> 00:15:21.986
therapist, you're probably going to say,

00:15:22.067 --> 00:15:23.648
if you save one spinal fusion,

00:15:24.642 --> 00:15:27.503
You can probably pay for a thousand PT

00:15:27.523 --> 00:15:28.182
visits or more.

00:15:28.202 --> 00:15:29.163
Right.

00:15:29.224 --> 00:15:31.865
Wild.

00:15:31.884 --> 00:15:31.965
Yeah.

00:15:31.985 --> 00:15:32.105
I mean,

00:15:32.125 --> 00:15:33.184
we can do a lot with a thousand

00:15:33.205 --> 00:15:33.445
visits.

00:15:33.465 --> 00:15:34.966
Yeah.

00:15:35.466 --> 00:15:35.905
Well, yeah,

00:15:35.946 --> 00:15:37.647
we're arguing over five and we're

00:15:37.687 --> 00:15:39.028
skipping, we're stepping over a thousand.

00:15:39.668 --> 00:15:39.868
I,

00:15:39.988 --> 00:15:42.009
one of the first episodes I did ten

00:15:42.149 --> 00:15:45.090
years ago, talking to a sports PT,

00:15:45.289 --> 00:15:46.811
Eric Mara, and I remember I asked him,

00:15:46.870 --> 00:15:47.410
hey man, like,

00:15:48.403 --> 00:15:49.524
Because when I started PT school,

00:15:49.544 --> 00:15:50.585
it was the second career for me.

00:15:51.186 --> 00:15:54.027
I knew like post-surgical and sports and

00:15:54.107 --> 00:15:55.828
regular, regular PT, right?

00:15:55.869 --> 00:15:57.068
I didn't understand there was all this

00:15:57.109 --> 00:15:59.691
different stuff or each sports team had

00:15:59.831 --> 00:16:01.231
one embedded on the sideline.

00:16:01.272 --> 00:16:01.831
And I just said, hey,

00:16:01.851 --> 00:16:03.994
what's it take to be like a great

00:16:04.094 --> 00:16:04.874
sports PT?

00:16:04.894 --> 00:16:06.455
Because he had done some NBA stuff and

00:16:06.534 --> 00:16:07.395
NCAA stuff.

00:16:07.735 --> 00:16:09.277
And I was ready for this big fancy

00:16:09.417 --> 00:16:10.277
answer from this guy.

00:16:10.677 --> 00:16:11.918
And he gave me the three A's,

00:16:11.957 --> 00:16:14.100
which were you got to be available because

00:16:14.139 --> 00:16:15.520
sports are like twenty four seven.

00:16:16.201 --> 00:16:17.682
You got to be affable because these

00:16:17.761 --> 00:16:19.322
athletes like this is their job and they

00:16:19.342 --> 00:16:20.183
can work with anybody.

00:16:20.224 --> 00:16:21.144
So you better have a little bit of

00:16:21.164 --> 00:16:22.424
a personality and be affable.

00:16:22.966 --> 00:16:24.706
And then the third A blew me away.

00:16:24.726 --> 00:16:25.528
He goes adequate.

00:16:26.368 --> 00:16:27.828
He's I need to do the basics real

00:16:27.869 --> 00:16:28.149
well.

00:16:28.229 --> 00:16:28.450
He's like,

00:16:28.509 --> 00:16:29.350
I know you want to do the fan.

00:16:29.811 --> 00:16:31.251
I thought the answer was going to be

00:16:31.412 --> 00:16:32.732
lasers and this and this.

00:16:32.753 --> 00:16:35.534
And he just slapped me with adequate aim

00:16:35.575 --> 00:16:36.095
for adequate.

00:16:36.115 --> 00:16:36.575
And likely,

00:16:36.595 --> 00:16:38.596
if you do adequate enough over time,

00:16:38.836 --> 00:16:39.937
you're going to be above adequate.

00:16:40.602 --> 00:16:41.484
Right, for sure.

00:16:42.024 --> 00:16:43.924
I think that the same would be true

00:16:44.426 --> 00:16:46.106
with direct to employer contracting.

00:16:46.147 --> 00:16:46.486
Obviously,

00:16:46.527 --> 00:16:48.749
our goal is to be the best at

00:16:48.769 --> 00:16:49.308
what we do.

00:16:49.970 --> 00:16:52.552
And really,

00:16:52.572 --> 00:16:55.134
you have to be for a while to

00:16:55.274 --> 00:16:58.995
have enough data for the employer to

00:16:59.076 --> 00:17:00.216
actually pay attention to you.

00:17:01.437 --> 00:17:04.019
But there are people that do direct to

00:17:04.039 --> 00:17:06.682
employer contracting that don't measure

00:17:06.701 --> 00:17:07.442
clinical outcomes.

00:17:08.641 --> 00:17:10.143
And I want to do it with a

00:17:10.182 --> 00:17:12.224
third party so they can't say I

00:17:12.506 --> 00:17:13.266
manipulated it.

00:17:13.386 --> 00:17:15.449
Anyway, been there, done that.

00:17:16.289 --> 00:17:18.071
You know, I've heard that song and dance.

00:17:18.511 --> 00:17:19.894
So, you know, I'm like, look,

00:17:19.913 --> 00:17:20.954
you don't need to believe me.

00:17:21.095 --> 00:17:21.435
Ask them.

00:17:22.673 --> 00:17:22.874
You know,

00:17:22.894 --> 00:17:24.434
they'll tell you where I rank and,

00:17:24.894 --> 00:17:25.115
you know,

00:17:25.154 --> 00:17:26.376
but this is why I'm going to do

00:17:26.396 --> 00:17:27.037
what I'm going to do.

00:17:27.136 --> 00:17:27.837
And, you know,

00:17:27.877 --> 00:17:32.501
we have volumes of research that speaks to

00:17:33.522 --> 00:17:36.765
PT for low back pain seen within the

00:17:36.785 --> 00:17:37.746
first fourteen days,

00:17:37.965 --> 00:17:39.488
reducing fifty percent of downstream

00:17:39.508 --> 00:17:39.847
costs.

00:17:40.949 --> 00:17:41.930
If that's really true,

00:17:43.151 --> 00:17:44.832
why wouldn't every third party payer be

00:17:44.872 --> 00:17:45.333
all over it?

00:17:46.252 --> 00:17:48.194
Because because they're the incentives

00:17:48.214 --> 00:17:48.734
don't align.

00:17:48.755 --> 00:17:49.655
Right.

00:17:49.756 --> 00:17:50.297
What do you mean by that?

00:17:51.166 --> 00:17:55.530
So for PT, like nine, seven, one, one,

00:17:55.590 --> 00:17:57.952
oh, nine, seven, one, one, two,

00:17:58.313 --> 00:18:00.074
no one really knows what that buys.

00:18:01.454 --> 00:18:01.655
Right.

00:18:01.736 --> 00:18:02.876
Like, cause it's so very,

00:18:03.156 --> 00:18:03.876
it's a code for time.

00:18:04.557 --> 00:18:04.798
Right.

00:18:05.479 --> 00:18:05.939
Exactly.

00:18:06.720 --> 00:18:10.241
And versus for a third party payer,

00:18:11.323 --> 00:18:13.484
you know, they pay for a lumbar fusion.

00:18:14.226 --> 00:18:15.707
They know what that fusion is.

00:18:16.980 --> 00:18:20.222
we save money downstream that employer has

00:18:20.644 --> 00:18:22.826
or that insurance company rather has no

00:18:22.965 --> 00:18:24.948
idea if the employer is going to be

00:18:24.968 --> 00:18:27.529
with the same insurance company next year

00:18:27.589 --> 00:18:29.692
so they're not incented to save money

00:18:29.731 --> 00:18:31.933
today they're incented to have a finite

00:18:31.973 --> 00:18:35.116
expense today because their job is to make

00:18:35.136 --> 00:18:38.099
sure their shareholders are happy as the

00:18:38.140 --> 00:18:41.403
insurance company and so for the patient's

00:18:41.442 --> 00:18:41.983
perspective

00:18:43.075 --> 00:18:45.758
I think there's no argument that we do

00:18:45.798 --> 00:18:47.638
great for patients downstream.

00:18:48.799 --> 00:18:49.800
But for the payer,

00:18:50.701 --> 00:18:52.063
they want to keep that employee.

00:18:53.924 --> 00:18:56.126
Institutional knowledge gains year over

00:18:56.146 --> 00:18:57.808
year as that employee stays.

00:18:58.449 --> 00:19:00.971
And I think that employers started getting

00:19:00.991 --> 00:19:04.835
frustrated with every year my health

00:19:04.855 --> 00:19:05.655
expense goes up.

00:19:07.334 --> 00:19:08.153
And I kind of know that.

00:19:08.233 --> 00:19:08.413
Right.

00:19:08.433 --> 00:19:09.994
I'm watching the news that, you know,

00:19:10.194 --> 00:19:11.675
and whether you're on maybe you're on the

00:19:11.736 --> 00:19:12.336
state exchange,

00:19:12.355 --> 00:19:13.996
it's going up seventeen percent this year

00:19:14.016 --> 00:19:14.476
or whatever.

00:19:15.376 --> 00:19:16.656
And they're going, you know,

00:19:16.696 --> 00:19:18.278
like I kind of know that this expense

00:19:18.298 --> 00:19:18.978
is going to go up.

00:19:19.057 --> 00:19:21.878
But the problem part is it's going up.

00:19:22.159 --> 00:19:23.679
And my employees tell me they hate it.

00:19:25.119 --> 00:19:26.359
Like this is a real problem.

00:19:26.420 --> 00:19:28.060
If I'm spending a ton of money and

00:19:28.080 --> 00:19:29.000
they're mad at me for it.

00:19:29.080 --> 00:19:29.821
Right.

00:19:29.842 --> 00:19:31.082
I got to have a different plan.

00:19:31.102 --> 00:19:32.942
So that's kind of where I tried to

00:19:33.182 --> 00:19:34.022
insert myself.

00:19:34.557 --> 00:19:36.198
Yeah.

00:19:36.218 --> 00:19:37.980
Let's change to a different topic that I

00:19:38.000 --> 00:19:38.640
don't understand,

00:19:38.740 --> 00:19:39.840
which is a lot of things.

00:19:40.761 --> 00:19:42.643
You started PT Management Group of

00:19:42.663 --> 00:19:44.605
Virginia, but it's not a business.

00:19:45.464 --> 00:19:47.767
What is it and why did it matter

00:19:47.787 --> 00:19:48.307
to you to start?

00:19:48.346 --> 00:19:49.448
What is this thing and why did you

00:19:49.468 --> 00:19:51.009
do it?

00:19:51.028 --> 00:19:52.830
So in twenty fifteen,

00:19:54.352 --> 00:19:56.532
I originally thought, you know,

00:19:56.554 --> 00:19:57.954
I'm going to get a group of practices

00:19:57.974 --> 00:19:59.496
together and we're all going to band

00:19:59.516 --> 00:20:02.238
together and we're going to negotiate

00:20:02.278 --> 00:20:03.759
better contracts with insurance companies.

00:20:04.861 --> 00:20:07.221
which sounds fantastic until you realize

00:20:07.261 --> 00:20:09.584
that there's one tax ID number in that.

00:20:10.183 --> 00:20:12.065
And so that means everybody else would

00:20:12.085 --> 00:20:13.605
have to give up their tax ID number

00:20:13.625 --> 00:20:14.606
or I would have to give up my

00:20:14.646 --> 00:20:17.147
tax ID number so we can negotiate under

00:20:17.328 --> 00:20:17.489
one.

00:20:18.509 --> 00:20:20.230
That was too much risk for private

00:20:20.269 --> 00:20:20.810
practices.

00:20:21.330 --> 00:20:22.751
They didn't trust each other that much.

00:20:23.332 --> 00:20:23.992
So I said, okay,

00:20:24.917 --> 00:20:28.141
we got to do something that keeps private

00:20:28.181 --> 00:20:29.000
practices private.

00:20:29.882 --> 00:20:33.304
And because selling to institutions,

00:20:33.644 --> 00:20:35.145
let's just call it institutions.

00:20:35.326 --> 00:20:36.646
So we don't stomp on any toes.

00:20:37.508 --> 00:20:39.009
I never saw people go like that, man.

00:20:39.028 --> 00:20:39.588
That was awesome.

00:20:40.390 --> 00:20:42.511
You know, like it was always kind of,

00:20:42.791 --> 00:20:44.232
yeah, I sold my soul to the devil,

00:20:44.673 --> 00:20:44.952
you know,

00:20:45.032 --> 00:20:46.954
like they just were generally unhappy.

00:20:46.994 --> 00:20:47.375
So I'm like,

00:20:47.535 --> 00:20:48.997
maybe we could find a way that we

00:20:49.017 --> 00:20:50.758
could keep private practices private.

00:20:51.278 --> 00:20:53.980
And so that became like a managed services

00:20:54.039 --> 00:20:54.621
organization.

00:20:55.358 --> 00:20:56.279
So functionally,

00:20:56.500 --> 00:21:00.201
I became big brother to practices in the

00:21:00.241 --> 00:21:03.424
state of Virginia where I vetted EMR

00:21:03.444 --> 00:21:05.526
systems and I negotiated discounts.

00:21:06.125 --> 00:21:08.708
And so there is an expense to join

00:21:08.748 --> 00:21:09.429
PTMG.

00:21:10.449 --> 00:21:11.150
It's fifty dollars.

00:21:12.460 --> 00:21:14.422
which functionally covers my legal fees,

00:21:14.481 --> 00:21:15.462
I hope, you know,

00:21:16.202 --> 00:21:17.743
so when I'm vetting contracts,

00:21:17.784 --> 00:21:20.946
but that's what it's delved into.

00:21:21.586 --> 00:21:22.827
And, you know,

00:21:22.847 --> 00:21:24.630
we've kind of branched into North Carolina

00:21:24.670 --> 00:21:25.069
as well,

00:21:25.130 --> 00:21:26.790
just because people were asking for some

00:21:26.810 --> 00:21:27.872
help.

00:21:27.892 --> 00:21:30.594
But we found ways to bring less expensive

00:21:30.653 --> 00:21:31.375
EMR systems,

00:21:31.474 --> 00:21:33.797
less expensive scribe documentation,

00:21:34.196 --> 00:21:35.458
you know, AI documentation,

00:21:36.155 --> 00:21:39.318
billing companies, medical supplies,

00:21:39.378 --> 00:21:40.220
office supplies,

00:21:41.480 --> 00:21:43.824
and we can get better pricing because

00:21:43.864 --> 00:21:45.305
we're negotiating as a large group.

00:21:45.865 --> 00:21:46.486
Strength in numbers.

00:21:47.467 --> 00:21:47.686
Right.

00:21:48.208 --> 00:21:52.551
So it really, if I cashed out today,

00:21:53.992 --> 00:21:56.336
I wouldn't get to a comma.

00:21:56.395 --> 00:21:57.616
There wouldn't be a comma in the numbers.

00:21:58.298 --> 00:21:58.557
You know,

00:22:00.278 --> 00:22:02.601
and it never was designed to be a

00:22:02.641 --> 00:22:04.261
financially viable source.

00:22:04.721 --> 00:22:07.384
It was designed to keep PTs doing what

00:22:07.403 --> 00:22:10.086
they had a passion to do and doing

00:22:10.105 --> 00:22:11.846
it the way that they thought they could

00:22:11.886 --> 00:22:12.547
do it best.

00:22:13.708 --> 00:22:16.910
And I think I've achieved that goal.

00:22:17.750 --> 00:22:18.611
And, you know,

00:22:18.931 --> 00:22:20.332
I'll keep doing that as long as I

00:22:20.372 --> 00:22:20.491
can.

00:22:21.067 --> 00:22:21.968
you know,

00:22:21.988 --> 00:22:24.288
put one foot in front of the other.

00:22:24.308 --> 00:22:24.388
Yeah.

00:22:24.409 --> 00:22:24.588
All right.

00:22:24.608 --> 00:22:25.368
We're going to take a break.

00:22:25.388 --> 00:22:26.950
I got to pay some bills here.

00:22:27.049 --> 00:22:29.491
Brooks IHL shows power by Brooks IHL over

00:22:29.511 --> 00:22:30.172
the last couple of years,

00:22:30.551 --> 00:22:32.792
world-class residencies and fellowships

00:22:33.212 --> 00:22:35.234
built around real world patient care,

00:22:35.295 --> 00:22:37.395
pediatrics, geriatrics, orthopedics,

00:22:37.476 --> 00:22:39.696
neuro, women's health,

00:22:40.136 --> 00:22:42.637
brooksihl.org down in Jacksonville,

00:22:42.699 --> 00:22:44.819
brooksihl.org.

00:22:45.759 --> 00:22:47.901
See what the future of your career could

00:22:47.941 --> 00:22:50.001
look like with a residency or fellowship

00:22:50.122 --> 00:22:50.561
at Brooks.

00:22:50.582 --> 00:22:52.603
That's brooksihl.org.

00:22:52.762 --> 00:22:57.685
All right, that's the break there.

00:22:59.267 --> 00:23:00.967
You teach a foot and ankle course based

00:23:01.027 --> 00:23:04.308
on what you say school got wrong.

00:23:04.528 --> 00:23:05.108
I love that.

00:23:05.609 --> 00:23:08.510
What's the biggest misconception PTs have

00:23:08.530 --> 00:23:11.291
about plantar fasciitis or maybe just

00:23:11.311 --> 00:23:12.413
diagnosis in general?

00:23:12.553 --> 00:23:14.493
What are we close but not exactly on

00:23:14.513 --> 00:23:14.854
the button?

00:23:16.334 --> 00:23:19.797
So I'm going to back up before I

00:23:19.876 --> 00:23:22.019
answer that question and just get to how

00:23:22.098 --> 00:23:22.679
I got there.

00:23:22.818 --> 00:23:24.780
Yeah, I like that.

00:23:25.541 --> 00:23:28.544
So I grew up thinking I wanted to

00:23:28.564 --> 00:23:29.404
be a physical therapist.

00:23:30.144 --> 00:23:32.507
My father was in a very bad motorcycle

00:23:32.606 --> 00:23:34.888
accident when I was seven.

00:23:36.049 --> 00:23:36.691
Spinal injuries,

00:23:36.711 --> 00:23:38.711
he had burst fractures from T-ten to

00:23:38.731 --> 00:23:39.413
L-five.

00:23:40.574 --> 00:23:41.894
Thought he was going to be paralyzed,

00:23:42.115 --> 00:23:43.375
said he wouldn't walk again.

00:23:44.109 --> 00:23:45.269
Well, he walked, he lived,

00:23:45.309 --> 00:23:46.351
he did all the things.

00:23:47.010 --> 00:23:47.891
And through that,

00:23:47.931 --> 00:23:49.731
he wasn't saying the trauma surgeon saved

00:23:49.771 --> 00:23:50.231
my life.

00:23:50.271 --> 00:23:51.972
He was saying the PT saved my life.

00:23:52.452 --> 00:23:54.353
So I grew up thinking PT was like

00:23:54.393 --> 00:23:54.972
super special.

00:23:54.992 --> 00:24:02.355
That I wanted to do foot and ankle.

00:24:03.316 --> 00:24:05.557
I wasn't the prototypical PT student.

00:24:06.136 --> 00:24:07.537
I went to PT school saying I'm gonna

00:24:07.557 --> 00:24:08.698
be a foot and ankle PT.

00:24:09.873 --> 00:24:12.013
And my professor said, well,

00:24:12.034 --> 00:24:14.115
you have to do an acute care rotation

00:24:14.134 --> 00:24:14.994
and then skilled care.

00:24:15.015 --> 00:24:16.256
And I'm like, nope.

00:24:18.455 --> 00:24:20.297
And I didn't really understand why they

00:24:20.336 --> 00:24:20.757
cared.

00:24:20.916 --> 00:24:22.258
You know, I thought it was my problem.

00:24:22.278 --> 00:24:24.519
And, you know, so anyhow,

00:24:25.598 --> 00:24:27.579
I focused all on foot and ankle for

00:24:27.619 --> 00:24:28.079
forever.

00:24:28.099 --> 00:24:31.161
And I treated other things when I wasn't

00:24:31.201 --> 00:24:32.422
well known enough to treat them.

00:24:32.801 --> 00:24:35.744
foot and ankle only um but through that

00:24:35.785 --> 00:24:38.567
process i started following podiatrists

00:24:38.807 --> 00:24:41.911
and orthopedic surgeons and um you know

00:24:41.931 --> 00:24:43.352
and i you know got to hang out

00:24:43.372 --> 00:24:46.815
with some real gurus and uh and see

00:24:47.596 --> 00:24:49.317
what everybody was doing and there's some

00:24:49.478 --> 00:24:51.019
really great foot and ankle physical

00:24:51.038 --> 00:24:52.200
therapists particularly in the eighties

00:24:52.240 --> 00:24:54.321
and nineties and i spent time with them

00:24:55.202 --> 00:24:57.884
And what I realized was we're all trying

00:24:57.904 --> 00:24:58.744
to do the same thing,

00:24:59.144 --> 00:25:00.786
but they're they're trying to do it four

00:25:00.826 --> 00:25:01.185
different ways.

00:25:01.205 --> 00:25:01.405
Right.

00:25:01.987 --> 00:25:04.708
Like pedorthics has, you know,

00:25:04.728 --> 00:25:06.469
the foot and ankle appliance approach.

00:25:06.528 --> 00:25:09.250
And orthopedics is really very good at

00:25:09.269 --> 00:25:12.011
differential diagnosis, you know,

00:25:12.051 --> 00:25:13.853
with with they have a lot of special

00:25:13.893 --> 00:25:14.913
tests at their disposal.

00:25:14.952 --> 00:25:17.054
But orthopedics usually get the diagnosis

00:25:17.094 --> 00:25:18.035
right more often than not.

00:25:18.694 --> 00:25:21.436
Podiatrists really can also do the same

00:25:21.457 --> 00:25:21.576
thing.

00:25:21.616 --> 00:25:22.498
That's very regional.

00:25:24.439 --> 00:25:26.019
East Coast versus West Coast podiatry

00:25:26.039 --> 00:25:27.441
seems to be quite different to me.

00:25:28.622 --> 00:25:31.064
But many understand biomechanics very

00:25:31.104 --> 00:25:31.384
well,

00:25:31.503 --> 00:25:33.566
but their biomechanics kind of stop at the

00:25:33.605 --> 00:25:34.567
knee.

00:25:35.507 --> 00:25:37.368
And PTs are supposed to be the function

00:25:37.388 --> 00:25:37.648
group.

00:25:38.308 --> 00:25:42.412
And we learn a lot about evaluation and

00:25:42.471 --> 00:25:44.814
not that much about treatment and really

00:25:44.854 --> 00:25:45.954
very little about function.

00:25:47.096 --> 00:25:48.176
yet then we're supposed to go treat

00:25:48.196 --> 00:25:49.897
patients and do function so as i was

00:25:49.938 --> 00:25:52.557
trying to roll all those things together i

00:25:52.617 --> 00:25:54.659
realized that the only real right answer

00:25:54.679 --> 00:25:56.939
was to pull research from all of them

00:25:57.118 --> 00:26:00.440
and um and understand what the other

00:26:00.460 --> 00:26:02.420
groups were talking about so to answer

00:26:02.440 --> 00:26:05.480
your question about plantar fasciitis um

00:26:05.560 --> 00:26:09.402
about ten percent uh in my estimation of

00:26:09.521 --> 00:26:11.481
what comes into a pt clinic diagnosis

00:26:11.501 --> 00:26:14.282
plantar fasciitis actually has pathology

00:26:14.423 --> 00:26:15.323
to the plantar fascia

00:26:16.731 --> 00:26:18.513
It's some other structure.

00:26:19.275 --> 00:26:21.396
And, you know,

00:26:21.497 --> 00:26:23.680
as simple as if you put if the

00:26:23.720 --> 00:26:26.041
plantar fascia is the problem and you put

00:26:26.082 --> 00:26:28.986
the plantar fascia on load and then you

00:26:29.026 --> 00:26:29.726
palpate it,

00:26:30.467 --> 00:26:32.328
you would anticipate that that plantar

00:26:32.348 --> 00:26:33.810
fascia would be more painful.

00:26:35.325 --> 00:26:36.705
But more often than not,

00:26:36.786 --> 00:26:38.606
those patients diagnosed with plantar

00:26:38.646 --> 00:26:39.968
fasciitis in a PT clinic,

00:26:40.188 --> 00:26:43.289
if you do a windlass mechanism and you

00:26:43.309 --> 00:26:45.332
extend their great toe or all of their

00:26:45.372 --> 00:26:47.212
toes, the plantar fascia is taught,

00:26:47.272 --> 00:26:48.133
their pain goes away.

00:26:49.773 --> 00:26:52.175
And, you know, PT school, you know,

00:26:52.355 --> 00:26:53.457
we're taught to, you know,

00:26:53.497 --> 00:26:54.958
it's an inflammatory reaction.

00:26:54.998 --> 00:26:55.637
It's an itis.

00:26:56.138 --> 00:26:56.699
You know,

00:26:56.778 --> 00:26:58.460
you're going to do your calm it down

00:26:58.660 --> 00:26:59.461
type treatments.

00:27:00.432 --> 00:27:01.713
And then the patient goes,

00:27:02.034 --> 00:27:03.595
it felt better while you were doing it.

00:27:03.795 --> 00:27:05.515
Yeah.

00:27:06.395 --> 00:27:08.317
But we don't have a great history.

00:27:08.676 --> 00:27:10.278
And that's why the research looks like

00:27:10.337 --> 00:27:11.377
what it looks like for PT.

00:27:11.397 --> 00:27:13.598
It's like PT might help.

00:27:13.638 --> 00:27:14.500
PT might not help.

00:27:14.579 --> 00:27:15.579
Orthotics might help.

00:27:15.819 --> 00:27:17.201
Maybe over-the-counter products.

00:27:18.422 --> 00:27:19.541
Maybe it's walking barefooted.

00:27:19.662 --> 00:27:20.982
Maybe you need a different shoe.

00:27:21.563 --> 00:27:24.704
And it's all of these maybes when probably

00:27:24.744 --> 00:27:25.444
the issue is,

00:27:26.621 --> 00:27:28.821
The most common diagnosis is a muscle

00:27:28.842 --> 00:27:29.122
problem,

00:27:29.162 --> 00:27:31.663
like it's a tendinopathy and that causes

00:27:31.702 --> 00:27:32.282
heel pain.

00:27:33.482 --> 00:27:34.124
There's others.

00:27:34.144 --> 00:27:35.544
There's seventy two things that cause heel

00:27:35.584 --> 00:27:35.884
pain,

00:27:36.723 --> 00:27:38.444
like pathologies that cause heel pain.

00:27:38.484 --> 00:27:41.266
But the most common is flexor digitorum

00:27:41.286 --> 00:27:42.405
brevis tendinopathy.

00:27:43.307 --> 00:27:46.127
And you can find that in research outside

00:27:46.167 --> 00:27:46.508
of PT.

00:27:46.607 --> 00:27:49.469
You can't really find that in PT research

00:27:49.509 --> 00:27:49.828
that well.

00:27:51.601 --> 00:27:53.041
So then you decided to teach a course

00:27:53.061 --> 00:27:54.082
because you, what,

00:27:54.382 --> 00:27:56.323
I'm guessing you had all this special

00:27:56.363 --> 00:27:57.202
knowledge and you're like, hey,

00:27:57.222 --> 00:27:58.243
the way to do it or the way

00:27:58.284 --> 00:27:59.824
to touch the most people is to teach

00:27:59.844 --> 00:28:00.223
the teacher?

00:28:01.765 --> 00:28:02.724
I wish that were true.

00:28:04.346 --> 00:28:04.925
Honestly,

00:28:07.807 --> 00:28:09.188
I had been practicing for about a year

00:28:09.208 --> 00:28:10.048
and a half, two years,

00:28:10.488 --> 00:28:12.548
and I studied only foot and ankle.

00:28:13.108 --> 00:28:13.828
And I said,

00:28:14.069 --> 00:28:15.269
how am I going to make sure?

00:28:15.829 --> 00:28:18.391
I had this crazy goal of being the

00:28:18.411 --> 00:28:19.852
best foot and ankle physical therapist in

00:28:19.892 --> 00:28:20.251
the world.

00:28:21.270 --> 00:28:22.791
I don't even know how you measure that.

00:28:23.153 --> 00:28:24.094
Right.

00:28:24.114 --> 00:28:26.655
I had this ideology that that was what

00:28:26.675 --> 00:28:27.175
I was going to do.

00:28:27.936 --> 00:28:31.961
So I decided I would create a course.

00:28:33.038 --> 00:28:34.598
with no one to buy it, right?

00:28:35.259 --> 00:28:36.679
No one to even market it to.

00:28:37.000 --> 00:28:38.259
No one who would even care.

00:28:39.559 --> 00:28:42.201
But I would use that as my discipline

00:28:42.240 --> 00:28:45.262
tool to comb through the research,

00:28:45.502 --> 00:28:47.042
understand differential diagnosis,

00:28:47.222 --> 00:28:49.463
understand actual functional change.

00:28:50.585 --> 00:28:52.865
Because our books were so challenging.

00:28:54.326 --> 00:28:56.866
If you ask a PT,

00:28:56.906 --> 00:28:58.968
what's the purpose of the gastroc?

00:28:59.008 --> 00:29:01.108
What's the action of the gastroc?

00:29:01.169 --> 00:29:02.229
It's plantar flexion.

00:29:03.496 --> 00:29:05.717
which is a hundred percent true unless the

00:29:05.757 --> 00:29:09.318
patient stands up and then his job is

00:29:09.338 --> 00:29:10.500
to decelerate the tibia.

00:29:10.539 --> 00:29:12.059
And,

00:29:12.079 --> 00:29:14.481
but we don't train deceleration of the

00:29:14.521 --> 00:29:15.981
tibia that often in the clinic.

00:29:16.962 --> 00:29:18.864
And so anyhow,

00:29:19.003 --> 00:29:21.305
I used that as an approach to make

00:29:21.345 --> 00:29:22.746
me a better PT.

00:29:23.645 --> 00:29:25.887
And then after about three years of

00:29:26.288 --> 00:29:28.489
culminating all of that, I was like,

00:29:29.493 --> 00:29:31.035
I think this could be a course now.

00:29:31.414 --> 00:29:34.257
And, um, and then thankfully, you know,

00:29:34.336 --> 00:29:35.698
one thing led to another and a few

00:29:35.738 --> 00:29:38.079
people started calling and, um, I,

00:29:38.099 --> 00:29:40.301
I taught with North American seminars for.

00:29:41.182 --> 00:29:43.183
Twenty years or so.

00:29:43.463 --> 00:29:44.644
And then private,

00:29:45.105 --> 00:29:46.726
I use COVID as kind of my break.

00:29:47.606 --> 00:29:48.426
And, um,

00:29:48.507 --> 00:29:50.087
and then I've just done private courses

00:29:50.127 --> 00:29:50.608
since then.

00:29:50.689 --> 00:29:51.009
I kind of,

00:29:51.297 --> 00:29:52.538
I have a level one course,

00:29:52.557 --> 00:29:55.159
which is like an advanced evaluation and

00:29:55.199 --> 00:29:56.380
treatment of foot and ankle course.

00:29:56.880 --> 00:29:58.101
And then a level two course,

00:29:58.121 --> 00:30:00.602
which I call beyond the textbooks.

00:30:01.301 --> 00:30:04.463
It's the things that you really can't find

00:30:04.523 --> 00:30:05.203
in one place.

00:30:05.724 --> 00:30:07.905
And like tricks of the trade.

00:30:08.806 --> 00:30:09.186
To me,

00:30:09.247 --> 00:30:11.827
that was the part that kind of rejuvenated

00:30:11.867 --> 00:30:12.008
me.

00:30:12.028 --> 00:30:13.548
And it's like, oh, that's super cool.

00:30:14.028 --> 00:30:15.049
And, you know,

00:30:15.069 --> 00:30:16.450
it's kind of like the first time you

00:30:16.509 --> 00:30:17.651
learn spinal manipulations.

00:30:18.880 --> 00:30:20.040
You watch people do it and you're like,

00:30:20.080 --> 00:30:21.342
man, that's awesome.

00:30:21.741 --> 00:30:22.762
And then you try to do it and

00:30:22.782 --> 00:30:25.384
you're like, I'm not very good at it.

00:30:26.265 --> 00:30:27.806
And then the first time you can

00:30:27.865 --> 00:30:30.688
repetitively create a cavitation,

00:30:30.887 --> 00:30:35.089
you're like, yeah, I've arrived.

00:30:35.470 --> 00:30:40.814
And so I tried to create those summaries

00:30:41.153 --> 00:30:42.575
of if you see this,

00:30:42.714 --> 00:30:44.915
then here are maybe the three to five

00:30:44.935 --> 00:30:46.176
things you should be thinking about.

00:30:47.048 --> 00:30:47.948
How are you going to rule it in,

00:30:47.988 --> 00:30:48.409
rule it out?

00:30:48.429 --> 00:30:50.130
How are you going to know if the

00:30:50.170 --> 00:30:51.130
patient's getting better?

00:30:51.930 --> 00:30:52.971
How do you know if you're on the

00:30:53.030 --> 00:30:54.951
right plane of treatment?

00:30:54.971 --> 00:30:55.672
You know,

00:30:55.711 --> 00:30:57.232
what's a reasonable timeframe for

00:30:57.272 --> 00:30:57.692
treatment?

00:30:58.192 --> 00:30:59.953
What are the things that you shouldn't

00:30:59.993 --> 00:31:00.454
even treat?

00:31:01.055 --> 00:31:03.276
Like we know historically we fail at,

00:31:03.336 --> 00:31:04.596
maybe we just need a punt.

00:31:05.436 --> 00:31:07.617
So anyway, that's how it all came about.

00:31:07.657 --> 00:31:08.077
It wasn't,

00:31:09.058 --> 00:31:10.839
it wasn't this cool knowledge set.

00:31:10.859 --> 00:31:10.940
Yeah.

00:31:11.380 --> 00:31:12.660
But you sort of,

00:31:14.300 --> 00:31:15.382
you started with the end in mind.

00:31:16.573 --> 00:31:17.432
And the end,

00:31:19.354 --> 00:31:20.953
you created an obstacle course for

00:31:20.993 --> 00:31:24.095
yourself and you made it at such a

00:31:24.214 --> 00:31:27.675
level that eventually the audience found

00:31:27.695 --> 00:31:27.796
you.

00:31:27.875 --> 00:31:28.997
They started sniffing around.

00:31:29.836 --> 00:31:31.136
Once you started letting people know that

00:31:31.176 --> 00:31:32.897
this thing that you created was there,

00:31:34.958 --> 00:31:36.439
that's the way to actually do it.

00:31:37.398 --> 00:31:38.179
The opposite would be like,

00:31:39.099 --> 00:31:39.940
who do we sell to?

00:31:41.007 --> 00:31:42.868
right where it should be like what do

00:31:42.909 --> 00:31:44.269
i care about what am i willing to

00:31:44.289 --> 00:31:46.251
do push-ups for even if i get no

00:31:46.311 --> 00:31:48.994
return i'm still getting muscles out of it

00:31:49.375 --> 00:31:50.757
and then you were like well other people

00:31:50.797 --> 00:31:52.258
want this path too look at all the

00:31:52.278 --> 00:31:54.259
put look all the work i've done you

00:31:54.299 --> 00:31:55.780
started with the end in mind which is

00:31:56.001 --> 00:31:58.163
even if nobody i told people this before

00:31:58.804 --> 00:31:59.785
even if you have a pod like we

00:31:59.805 --> 00:32:01.267
could use it as a parallel

00:32:02.107 --> 00:32:02.989
Even if you go to write a book

00:32:03.028 --> 00:32:04.469
or even if you launch a podcast and

00:32:04.528 --> 00:32:06.369
no one reads it or no one listens

00:32:06.410 --> 00:32:07.990
to it, you did the work.

00:32:08.131 --> 00:32:09.511
You got to interview the people.

00:32:09.912 --> 00:32:10.752
You walked away.

00:32:10.772 --> 00:32:12.232
It's a giant cheat code for life.

00:32:12.653 --> 00:32:14.174
But you could do this at a laundromat

00:32:14.255 --> 00:32:15.515
or a bar or street corner,

00:32:15.535 --> 00:32:18.217
which is if you ask enough questions and

00:32:18.257 --> 00:32:20.137
shut your mouth long enough to let people

00:32:20.238 --> 00:32:21.478
answer, you can learn.

00:32:21.979 --> 00:32:22.578
You can learn.

00:32:23.078 --> 00:32:23.519
Period.

00:32:23.579 --> 00:32:24.079
Hard stop.

00:32:25.855 --> 00:32:25.935
Yeah,

00:32:25.955 --> 00:32:27.876
and that's exactly how it came about.

00:32:28.196 --> 00:32:32.538
And I forced myself to look at things

00:32:32.597 --> 00:32:35.638
that maybe I had been told were wrong.

00:32:36.179 --> 00:32:39.039
It's like, well, why would they do that?

00:32:39.799 --> 00:32:41.141
What were they trying to achieve?

00:32:41.641 --> 00:32:47.122
And I was reading research that really I

00:32:47.221 --> 00:32:50.163
had learned in school was not valid.

00:32:51.042 --> 00:32:52.483
Like, oh, that's from the fifties.

00:32:53.955 --> 00:32:56.637
Like, that makes it wrong, right?

00:32:56.678 --> 00:32:58.138
But when I started going through and

00:32:58.358 --> 00:33:00.660
understanding what their methodology was

00:33:00.701 --> 00:33:02.541
and why they were trying to approach it

00:33:02.561 --> 00:33:03.461
the way they were approaching it,

00:33:03.481 --> 00:33:03.863
I was like,

00:33:04.502 --> 00:33:06.203
maybe there's a lost piece in here.

00:33:06.644 --> 00:33:09.826
And so the more I learned, you know,

00:33:09.846 --> 00:33:11.268
over the last twenty eight years,

00:33:11.647 --> 00:33:13.148
the only common thing I can say is

00:33:13.189 --> 00:33:13.769
the more I learned,

00:33:13.788 --> 00:33:17.010
the less I'm confident about, you know,

00:33:17.050 --> 00:33:19.252
like the things that as maybe a new

00:33:19.333 --> 00:33:20.453
therapist, I was going,

00:33:20.773 --> 00:33:22.035
you always do this.

00:33:22.789 --> 00:33:24.269
there's not that many always and nevers

00:33:25.810 --> 00:33:26.151
for me anymore.

00:33:26.171 --> 00:33:27.510
Well, that's done in Kruger, right?

00:33:27.590 --> 00:33:30.090
Which is like, it's like when, you know,

00:33:30.111 --> 00:33:31.491
you get a new grad, myself included,

00:33:31.511 --> 00:33:32.832
that's why it's so easy to spot.

00:33:32.892 --> 00:33:34.912
Like, you know, your second, third year,

00:33:34.951 --> 00:33:36.192
maybe a year or two out of school,

00:33:36.212 --> 00:33:36.452
it's like,

00:33:36.893 --> 00:33:38.952
you're dangerous because you know enough,

00:33:39.512 --> 00:33:41.513
but you don't know what your blind spots

00:33:41.653 --> 00:33:41.814
are.

00:33:41.854 --> 00:33:42.753
But in the moment,

00:33:42.794 --> 00:33:44.634
it's like youth's wasted on the young,

00:33:44.653 --> 00:33:45.434
myself included.

00:33:45.474 --> 00:33:46.454
It's like, oh no,

00:33:46.555 --> 00:33:47.795
I know lots of stuff.

00:33:47.954 --> 00:33:50.134
And then you get some reps and that's

00:33:50.154 --> 00:33:51.175
the difference between knowledge and

00:33:51.215 --> 00:33:51.836
wisdom, right?

00:33:51.915 --> 00:33:52.516
It feels like.

00:33:52.875 --> 00:33:53.817
Right.

00:33:53.836 --> 00:33:55.038
Yeah, I couldn't agree more.

00:33:55.198 --> 00:33:55.798
And, you know,

00:33:55.818 --> 00:33:57.441
I've actually looked at some data that,

00:33:57.740 --> 00:33:59.461
you know, for PTs, like,

00:33:59.903 --> 00:34:01.565
when are you really good?

00:34:01.585 --> 00:34:02.365
Right.

00:34:02.705 --> 00:34:04.207
And the data is like between year eight

00:34:04.227 --> 00:34:05.048
and year fifteen.

00:34:05.989 --> 00:34:06.710
And, you know,

00:34:06.809 --> 00:34:07.871
it's a hard pill to swallow, though,

00:34:07.911 --> 00:34:08.170
right?

00:34:09.324 --> 00:34:10.786
It especially if you're on the other side

00:34:10.806 --> 00:34:15.329
of fifteen, you know, but, you know,

00:34:15.369 --> 00:34:17.791
from year one to year eight, you know,

00:34:18.130 --> 00:34:18.931
you are learning,

00:34:19.652 --> 00:34:21.032
but you probably don't have enough reps.

00:34:21.054 --> 00:34:21.813
Right.

00:34:21.994 --> 00:34:22.815
And I mean,

00:34:22.835 --> 00:34:24.835
I'm just summarizing what I think the

00:34:24.856 --> 00:34:25.677
state is trying to say.

00:34:26.097 --> 00:34:27.418
And then after year fifteen,

00:34:27.657 --> 00:34:30.139
I jokingly say, like, you've arrived.

00:34:30.659 --> 00:34:31.561
And so you quit digging.

00:34:32.199 --> 00:34:32.458
You know,

00:34:32.539 --> 00:34:34.521
like you feel like you don't need to

00:34:34.581 --> 00:34:36.123
prove anything anymore so you can just

00:34:36.184 --> 00:34:37.045
rest on your laurels.

00:34:37.626 --> 00:34:39.807
And so you just slowly go away to

00:34:39.867 --> 00:34:40.248
nothing.

00:34:40.750 --> 00:34:41.230
And frankly,

00:34:41.250 --> 00:34:43.413
that scares me at twenty eight years.

00:34:43.492 --> 00:34:44.673
And I don't want to I don't want

00:34:44.693 --> 00:34:45.514
to be washed up.

00:34:46.076 --> 00:34:48.338
And and and so I have to have

00:34:48.418 --> 00:34:50.380
some reason to.

00:34:51.487 --> 00:34:53.668
be better tomorrow than I am today.

00:34:54.250 --> 00:34:55.670
And whether that's in leadership,

00:34:55.710 --> 00:34:57.231
whether that's as a clinician,

00:34:57.291 --> 00:34:58.811
whether that's as a business owner,

00:34:59.092 --> 00:34:59.592
whatever,

00:35:00.012 --> 00:35:02.554
those things still have to be true, um,

00:35:02.574 --> 00:35:03.414
to be successful.

00:35:03.434 --> 00:35:04.856
I think.

00:35:05.195 --> 00:35:06.456
Um, we didn't plan this,

00:35:06.516 --> 00:35:07.697
but who's on your bookshelf.

00:35:07.717 --> 00:35:10.980
You mentioned, uh, is Jim, Jim Collins.

00:35:11.000 --> 00:35:11.519
Good to great.

00:35:11.559 --> 00:35:12.181
That's on there.

00:35:12.641 --> 00:35:13.201
What else?

00:35:13.260 --> 00:35:14.262
What's, what's, what's,

00:35:14.362 --> 00:35:16.063
what's paralleling or what's on the side

00:35:16.322 --> 00:35:17.764
of the bookshelf if that one's on there?

00:35:19.556 --> 00:35:21.398
Um, paralleling, um,

00:35:23.981 --> 00:35:25.742
there's a book called on fire.

00:35:26.463 --> 00:35:26.963
Ooh, who's that?

00:35:28.985 --> 00:35:30.106
Well, I can, um, I'll look,

00:35:30.226 --> 00:35:31.507
I'll look it up, but what's it about?

00:35:32.427 --> 00:35:36.672
Um, it's about, uh, a young man who,

00:35:37.192 --> 00:35:37.532
um, was,

00:35:37.851 --> 00:35:40.594
was playing with fire and he caught on

00:35:40.635 --> 00:35:43.777
fire and gas and, and fireworks mixed.

00:35:44.217 --> 00:35:46.460
And he was burned over ninety percent of

00:35:46.500 --> 00:35:46.780
his body.

00:35:48.472 --> 00:35:49.873
And John O'Leary is his name.

00:35:49.913 --> 00:35:50.414
That's what it is.

00:35:50.454 --> 00:35:51.335
You're right, John O'Leary.

00:35:51.755 --> 00:35:54.237
Seven Choices to Ignite a Rackley-Inspired

00:35:54.297 --> 00:35:55.840
Life on Fire, John O'Leary.

00:35:56.260 --> 00:35:57.240
I've never heard of this before,

00:35:57.300 --> 00:35:57.942
so tell me about it.

00:35:59.003 --> 00:36:03.947
So he talks all about how physical therapy

00:36:03.967 --> 00:36:05.028
changed his life.

00:36:05.048 --> 00:36:06.490
Because at nine years old,

00:36:06.510 --> 00:36:07.851
he was burned over ninety percent of his

00:36:07.891 --> 00:36:08.233
body.

00:36:09.744 --> 00:36:09.903
you know,

00:36:09.943 --> 00:36:11.565
he went through some horrible burn

00:36:11.605 --> 00:36:13.585
treatments and then he, you know,

00:36:13.644 --> 00:36:15.385
he had amputations,

00:36:15.405 --> 00:36:16.846
he lost all of his fingers and,

00:36:17.246 --> 00:36:17.606
and his,

00:36:17.766 --> 00:36:22.228
and he had very significant inspirational

00:36:22.268 --> 00:36:23.307
moments in his life.

00:36:24.748 --> 00:36:25.309
And he,

00:36:25.509 --> 00:36:27.349
hearing his story and reading his book

00:36:27.469 --> 00:36:30.389
just really impacted me to the point where

00:36:30.510 --> 00:36:31.911
I called him up and said, I want,

00:36:32.190 --> 00:36:33.550
I want you to come and do a

00:36:33.590 --> 00:36:35.612
leadership talk for my team, you know,

00:36:35.632 --> 00:36:36.652
it'd be motivational.

00:36:37.192 --> 00:36:38.373
And then he told me his price and

00:36:38.413 --> 00:36:38.733
I'm like,

00:36:39.728 --> 00:36:40.907
What else you have?

00:36:40.967 --> 00:36:42.568
You got a cousin that could tell your

00:36:42.588 --> 00:36:42.829
story.

00:36:44.489 --> 00:36:45.989
So he agreed to do a video.

00:36:46.010 --> 00:36:46.449
Oh, that's great.

00:36:46.469 --> 00:36:48.590
And he tailored it to our team.

00:36:48.630 --> 00:36:51.711
And at the end of the video,

00:36:51.871 --> 00:36:53.992
every person in our room had tears

00:36:54.032 --> 00:36:54.952
streaming down their face.

00:36:55.413 --> 00:36:57.152
This man has no fingers, right?

00:36:57.172 --> 00:36:58.514
And he walked over and is pretty much

00:36:58.534 --> 00:36:59.693
saying, you know, listen,

00:36:59.753 --> 00:37:01.454
it comes down to grit, right?

00:37:01.534 --> 00:37:01.715
Like,

00:37:02.628 --> 00:37:04.168
Like, what's the next step?

00:37:04.188 --> 00:37:05.170
How are you going to move yourself

00:37:05.190 --> 00:37:05.510
forward?

00:37:05.889 --> 00:37:07.550
And as he walked over with no fingers,

00:37:07.570 --> 00:37:09.233
he sat down at the piano and he

00:37:09.273 --> 00:37:10.393
played Amazing Grace.

00:37:10.413 --> 00:37:11.653
Wow.

00:37:11.833 --> 00:37:14.775
And, you know, at this point, you're like,

00:37:15.137 --> 00:37:15.277
look,

00:37:15.356 --> 00:37:16.838
if I can't at least be a great

00:37:16.878 --> 00:37:18.818
PT, how bad am I?

00:37:18.998 --> 00:37:20.780
You know, like this guy has no,

00:37:20.940 --> 00:37:22.282
he could have given up on life.

00:37:23.402 --> 00:37:25.244
And now he's a public speaker and he

00:37:25.324 --> 00:37:26.565
owned a construction company.

00:37:26.585 --> 00:37:27.045
You know,

00:37:27.085 --> 00:37:28.965
like he had done all these great things.

00:37:30.027 --> 00:37:31.327
So that one was,

00:37:32.210 --> 00:37:34.411
it made me pay a lot of attention

00:37:34.452 --> 00:37:34.931
to grit.

00:37:35.851 --> 00:37:36.693
And, um,

00:37:36.773 --> 00:37:38.273
and then that led to like Angela

00:37:38.333 --> 00:37:40.376
Duckworth's book, um,

00:37:40.655 --> 00:37:41.757
passion and perseverance.

00:37:42.536 --> 00:37:44.838
Um, and, um, you know,

00:37:44.878 --> 00:37:46.440
and I've kind of tried to use those

00:37:46.460 --> 00:37:48.641
things to, to grow my practice.

00:37:49.302 --> 00:37:49.981
Um,

00:37:51.222 --> 00:37:54.425
I don't really think about hiring PTs much

00:37:54.465 --> 00:37:54.885
anymore.

00:37:55.306 --> 00:37:57.047
Um, you know, I think about hiring,

00:37:57.067 --> 00:38:00.429
you know, character, passion, integrity,

00:38:00.469 --> 00:38:01.130
and grit.

00:38:01.210 --> 00:38:01.409
Yeah.

00:38:01.775 --> 00:38:03.416
And if we have all those,

00:38:03.436 --> 00:38:04.538
we can do great.

00:38:04.617 --> 00:38:04.838
Yeah.

00:38:04.878 --> 00:38:05.998
I mean, like you hear often,

00:38:06.559 --> 00:38:08.340
especially now, you want to bring in AI,

00:38:08.400 --> 00:38:08.641
right?

00:38:08.802 --> 00:38:09.782
You've got people who are like,

00:38:09.802 --> 00:38:10.923
I'm applying for this job.

00:38:12.284 --> 00:38:14.086
And I think I check all the boxes

00:38:14.146 --> 00:38:15.789
on this description and I don't hear

00:38:15.829 --> 00:38:16.168
anything.

00:38:17.150 --> 00:38:18.471
And then you hear from recruiters who are

00:38:18.490 --> 00:38:18.690
like,

00:38:18.791 --> 00:38:19.873
it's because your stuff's going through

00:38:19.932 --> 00:38:19.992
AI.

00:38:20.132 --> 00:38:21.414
It's never hitting a human eyeball.

00:38:22.335 --> 00:38:22.755
Right.

00:38:22.916 --> 00:38:23.315
And you just,

00:38:23.416 --> 00:38:24.637
you have to wonder there's going to be

00:38:24.717 --> 00:38:24.918
some

00:38:26.123 --> 00:38:27.625
there's going to be some real loss by

00:38:27.684 --> 00:38:30.427
organizations or some real gain by the

00:38:30.487 --> 00:38:31.608
organizations who say,

00:38:31.889 --> 00:38:33.030
we're not going to do it this way.

00:38:33.110 --> 00:38:36.112
We're going to look for the person with

00:38:36.172 --> 00:38:36.494
grit.

00:38:36.793 --> 00:38:38.014
Because the smart people,

00:38:38.054 --> 00:38:40.456
the people sort of at the podium at

00:38:40.476 --> 00:38:42.679
these big organizations who've done it,

00:38:42.739 --> 00:38:44.201
maybe whatever your version of the right

00:38:44.240 --> 00:38:45.101
way is, has said...

00:38:45.862 --> 00:38:46.222
Listen,

00:38:46.842 --> 00:38:49.106
we can find people with skills or degrees.

00:38:49.166 --> 00:38:49.847
Look, they're out there.

00:38:49.867 --> 00:38:50.967
They're falling off of trees.

00:38:51.548 --> 00:38:52.510
You're looking for...

00:38:52.769 --> 00:38:54.391
And for people who maybe haven't heard

00:38:54.532 --> 00:38:55.353
Angela Duckworth,

00:38:55.773 --> 00:38:57.355
she's got a mathematical formula,

00:38:57.375 --> 00:38:58.856
which makes people like me tremble because

00:38:58.876 --> 00:38:59.518
I go, math.

00:38:59.757 --> 00:39:00.980
But this one has words in it,

00:39:01.000 --> 00:39:01.739
which is why I like it.

00:39:02.081 --> 00:39:04.282
So talent times effort equals skill.

00:39:05.554 --> 00:39:07.615
skill times effort equals achievement.

00:39:08.197 --> 00:39:09.356
And then she explained,

00:39:09.418 --> 00:39:11.018
she's got a great podcast as well called

00:39:11.059 --> 00:39:11.878
No Stupid Questions.

00:39:12.860 --> 00:39:14.099
She says, what do you notice there?

00:39:14.119 --> 00:39:15.161
And I'm like, I don't know.

00:39:15.541 --> 00:39:16.021
I see.

00:39:16.202 --> 00:39:16.981
I wouldn't have done it if it was

00:39:17.041 --> 00:39:17.362
math.

00:39:17.382 --> 00:39:20.423
But well, that skill word's there twice.

00:39:21.565 --> 00:39:23.065
Or sorry, effort's there.

00:39:23.306 --> 00:39:24.706
Which means effort is squared.

00:39:25.628 --> 00:39:26.909
So it's like, oh.

00:39:27.548 --> 00:39:28.710
So someone would have asked me, well,

00:39:28.730 --> 00:39:30.110
how'd you get so far in radio?

00:39:30.130 --> 00:39:30.971
Were you just real funny?

00:39:31.010 --> 00:39:32.112
I was like, I just kept showing up.

00:39:33.063 --> 00:39:33.682
Just kept showing up.

00:39:34.284 --> 00:39:35.164
Nope, here I am.

00:39:35.304 --> 00:39:36.764
I'm going to dress like a lion and

00:39:36.784 --> 00:39:38.865
hand out stickers at a Jiffy Lube.

00:39:39.186 --> 00:39:41.067
Or you're going to show up early.

00:39:41.086 --> 00:39:42.606
Whatever that is, the effort,

00:39:43.427 --> 00:39:45.869
hopefully it gets noticed because that's

00:39:46.028 --> 00:39:48.170
also not the only one.

00:39:48.489 --> 00:39:49.831
So talent's what you're born with.

00:39:50.150 --> 00:39:51.070
Skills are what you learn.

00:39:51.411 --> 00:39:54.253
So by all means, invest in skills.

00:39:55.458 --> 00:39:57.099
But if you're just taking con ed courses

00:39:57.119 --> 00:39:58.320
and you're not putting effort in,

00:39:58.940 --> 00:40:00.420
you're missing because that's that best.

00:40:00.541 --> 00:40:01.882
The effort is squared.

00:40:01.961 --> 00:40:03.682
The ROI is squared.

00:40:05.063 --> 00:40:05.804
A hundred percent.

00:40:06.085 --> 00:40:07.166
And and, you know,

00:40:07.246 --> 00:40:09.666
we spend an exorbitant amount of time

00:40:10.148 --> 00:40:12.708
trying to foster that and and letting

00:40:12.728 --> 00:40:13.789
people see, you know,

00:40:13.809 --> 00:40:15.190
when you put in this effort,

00:40:15.271 --> 00:40:16.371
this is what you get for it.

00:40:17.552 --> 00:40:21.315
And and it goes back to the first

00:40:21.335 --> 00:40:23.677
thing we talked about is like getting paid

00:40:23.717 --> 00:40:24.217
like a doctor.

00:40:25.987 --> 00:40:27.588
Do you have to know what it is

00:40:27.608 --> 00:40:28.088
in the beginning?

00:40:28.467 --> 00:40:30.327
Do you care about your hourly rate or

00:40:30.347 --> 00:40:31.628
do you care about your take home pay?

00:40:31.969 --> 00:40:33.389
Right.

00:40:33.409 --> 00:40:34.168
What's the goal here?

00:40:34.208 --> 00:40:35.088
What are we working towards?

00:40:35.708 --> 00:40:35.949
Right.

00:40:36.650 --> 00:40:39.130
And if we can all do that and

00:40:39.409 --> 00:40:41.130
recognize there's it's never a straight

00:40:41.150 --> 00:40:41.451
line.

00:40:41.751 --> 00:40:42.050
Right.

00:40:42.110 --> 00:40:43.630
It's always going to be hills and valleys.

00:40:43.650 --> 00:40:45.112
And, you know,

00:40:45.351 --> 00:40:48.833
and I think oftentimes like I'm worried my

00:40:48.853 --> 00:40:50.172
kids are probably going to be scarred

00:40:50.552 --> 00:40:53.574
because because I say, you know,

00:40:53.594 --> 00:40:54.833
you can be anything you want to be.

00:40:55.538 --> 00:40:56.759
But there's not a period at the end

00:40:56.818 --> 00:40:57.079
of that.

00:40:57.199 --> 00:40:58.019
That's a comma.

00:40:58.420 --> 00:40:59.641
As long as you work for it.

00:40:59.661 --> 00:41:00.760
Yeah, yeah, yeah.

00:41:01.242 --> 00:41:01.481
Good point.

00:41:01.501 --> 00:41:03.943
And we have so many people that just,

00:41:04.103 --> 00:41:05.264
you know, I've graduated.

00:41:05.384 --> 00:41:06.164
I've arrived.

00:41:06.264 --> 00:41:06.744
Here I am.

00:41:06.804 --> 00:41:07.326
I'm a doctor.

00:41:07.365 --> 00:41:08.025
I have a car.

00:41:08.126 --> 00:41:09.226
I should have a car and a big

00:41:09.286 --> 00:41:09.646
house.

00:41:09.726 --> 00:41:10.228
And, you know,

00:41:10.547 --> 00:41:14.429
like nobody who's ever done it did it

00:41:14.449 --> 00:41:14.971
that way.

00:41:15.110 --> 00:41:17.152
You know, like it just didn't happen.

00:41:17.492 --> 00:41:19.032
It's because somebody went out and made it

00:41:19.072 --> 00:41:19.494
happen.

00:41:19.713 --> 00:41:20.713
It's really funny because...

00:41:20.733 --> 00:41:21.534
I want to foster it.

00:41:21.855 --> 00:41:22.815
It's really funny because I work with a

00:41:22.835 --> 00:41:24.315
lot of creative people, obviously,

00:41:24.335 --> 00:41:26.056
in the nature of my former career.

00:41:26.275 --> 00:41:27.315
And then I became a PT,

00:41:27.335 --> 00:41:29.996
but now I do weird PT stuff adjacent.

00:41:30.597 --> 00:41:31.336
And it's funny.

00:41:31.818 --> 00:41:33.297
There's this guy named Chris Do.

00:41:33.657 --> 00:41:34.958
And he's a graphic designer,

00:41:35.358 --> 00:41:35.918
but he also...

00:41:37.259 --> 00:41:39.860
He'll teach other people value.

00:41:40.099 --> 00:41:41.119
So he's like a value guy.

00:41:41.619 --> 00:41:43.721
And he'll do these live Q&A sessions and

00:41:43.760 --> 00:41:45.380
say, well,

00:41:45.400 --> 00:41:47.161
how much does it cost for Chris to

00:41:47.181 --> 00:41:47.862
design a logo?

00:41:47.882 --> 00:41:49.141
And he goes, "'Ten thousand dollars.'"

00:41:49.894 --> 00:41:50.114
He's like,

00:41:50.135 --> 00:41:51.335
but it's going to take you an hour.

00:41:51.356 --> 00:41:52.695
And he goes, yeah,

00:41:52.735 --> 00:41:54.317
it took me ten thousand hours to do

00:41:54.496 --> 00:41:56.318
a great graphic in one hour.

00:41:56.699 --> 00:41:58.119
But if you want to pay me for

00:41:58.159 --> 00:41:58.599
the hours,

00:41:58.619 --> 00:42:00.039
I'll just take three weeks and still

00:42:00.059 --> 00:42:00.920
charge you ten grand.

00:42:01.161 --> 00:42:03.541
So do you value quality or time?

00:42:04.242 --> 00:42:06.262
And look, it's the same as PT.

00:42:06.724 --> 00:42:08.204
Well, I want to get more per hour.

00:42:08.224 --> 00:42:09.125
It's like, no, you don't.

00:42:09.324 --> 00:42:10.545
You want to get more per value.

00:42:10.585 --> 00:42:12.106
You want to sell the value,

00:42:13.266 --> 00:42:14.867
not the nine, seven, one, one, oh,

00:42:14.887 --> 00:42:15.708
that got you there.

00:42:15.748 --> 00:42:16.588
That ain't it, man.

00:42:16.608 --> 00:42:17.409
That's not the thing.

00:42:17.429 --> 00:42:18.610
That's the thing that helps you get to

00:42:18.630 --> 00:42:18.989
the thing.

00:42:20.134 --> 00:42:21.014
Right.

00:42:21.094 --> 00:42:23.655
And and those are directly parallel with

00:42:23.715 --> 00:42:24.876
direct to employer contract.

00:42:25.096 --> 00:42:26.036
Yeah.

00:42:26.056 --> 00:42:26.835
They want value.

00:42:26.876 --> 00:42:27.436
What do you want?

00:42:27.737 --> 00:42:29.916
They don't necessarily care what it costs.

00:42:29.936 --> 00:42:30.438
They don't.

00:42:30.677 --> 00:42:31.958
As long as they're getting what they pay

00:42:31.998 --> 00:42:32.237
for.

00:42:32.798 --> 00:42:34.559
And, you know,

00:42:34.599 --> 00:42:37.440
when when history has taught us that

00:42:37.460 --> 00:42:38.380
health care costs a lot,

00:42:38.400 --> 00:42:39.501
but you don't get much for it.

00:42:40.755 --> 00:42:42.876
Um, that's a bad value proposition.

00:42:42.916 --> 00:42:43.056
Well,

00:42:43.097 --> 00:42:44.958
I think it's the only lever to pull.

00:42:44.978 --> 00:42:45.619
All right, look,

00:42:45.699 --> 00:42:46.820
you just framed it really well.

00:42:46.940 --> 00:42:48.501
I got two sides to a seesaw.

00:42:48.760 --> 00:42:50.762
It's going to suck and it's going to

00:42:50.782 --> 00:42:51.483
be expensive.

00:42:51.623 --> 00:42:51.702
Well,

00:42:51.722 --> 00:42:53.324
can you just make the sucky stuff cheaper?

00:42:53.625 --> 00:42:55.646
It's harder to frame.

00:42:55.766 --> 00:42:57.547
I'm going to make the bad stuff better

00:42:57.887 --> 00:42:58.307
because that's,

00:42:58.768 --> 00:43:00.530
it's not tangible to people.

00:43:01.210 --> 00:43:02.451
So, you know, I,

00:43:02.471 --> 00:43:04.992
I give this example a lot, which is,

00:43:05.012 --> 00:43:05.052
uh,

00:43:07.199 --> 00:43:08.201
I love when I talk to a room

00:43:08.221 --> 00:43:09.722
full of clinicians and I'll go, hey,

00:43:10.143 --> 00:43:10.722
I'm just curious.

00:43:10.742 --> 00:43:11.623
I was just talking to my friend out

00:43:11.643 --> 00:43:11.963
in the hall.

00:43:12.264 --> 00:43:13.706
Who here has Amazon Prime?

00:43:13.885 --> 00:43:14.505
And of course,

00:43:14.887 --> 00:43:15.987
I'm asking a loaded question.

00:43:16.027 --> 00:43:17.048
Of course, ninety percent,

00:43:17.168 --> 00:43:18.250
ninety five percent of hands go up.

00:43:18.570 --> 00:43:19.871
And then I go, hey, man,

00:43:19.891 --> 00:43:20.711
you guys are all smart.

00:43:20.751 --> 00:43:21.572
You probably pay attention to your

00:43:21.592 --> 00:43:22.333
finances, right?

00:43:22.393 --> 00:43:22.612
Yeah.

00:43:22.853 --> 00:43:23.833
How much does that cost?

00:43:24.235 --> 00:43:25.375
Everybody gets real nervous.

00:43:25.394 --> 00:43:27.237
Like, oh, it's I think it's isn't it?

00:43:27.998 --> 00:43:29.378
And I ask that because.

00:43:31.789 --> 00:43:33.510
We don't necessarily, most of us,

00:43:33.710 --> 00:43:35.150
some people do, some people are sharp,

00:43:35.490 --> 00:43:36.692
but most of us don't.

00:43:37.293 --> 00:43:38.353
But internally,

00:43:38.452 --> 00:43:39.773
right down here in the gut,

00:43:40.054 --> 00:43:42.715
we know whatever it's worth isn't even

00:43:42.755 --> 00:43:44.157
close to what it costs.

00:43:45.277 --> 00:43:49.121
Bezos spends all day loading on the value

00:43:49.181 --> 00:43:51.242
side of the seesaw because he goes,

00:43:51.382 --> 00:43:52.844
I'm going to keep your eyes over here

00:43:53.144 --> 00:43:54.327
and you'll never look over here.

00:43:54.586 --> 00:43:56.309
We pay a hundred and thirty dollars a

00:43:56.349 --> 00:43:59.891
year to be allowed to buy stuff on

00:43:59.931 --> 00:44:00.693
his website.

00:44:01.213 --> 00:44:01.813
Not even that.

00:44:02.215 --> 00:44:04.056
You don't have to have a subscription to

00:44:04.097 --> 00:44:04.436
buy it.

00:44:04.956 --> 00:44:05.978
We buy it for...

00:44:07.266 --> 00:44:09.128
two-day shipping, free returns,

00:44:09.168 --> 00:44:11.130
and Amazon video, and Amazon photo,

00:44:11.170 --> 00:44:12.851
and Amazon this, and Amazon that.

00:44:12.931 --> 00:44:13.550
And it's funny.

00:44:13.590 --> 00:44:15.052
It's like, everybody's giggles.

00:44:15.072 --> 00:44:16.733
They're like, well, he's just real smart.

00:44:16.753 --> 00:44:17.012
And I go,

00:44:17.032 --> 00:44:17.833
I thought you were a room full of

00:44:17.873 --> 00:44:18.313
doctors.

00:44:18.333 --> 00:44:19.954
You can't figure out how to load one

00:44:19.994 --> 00:44:20.956
side and not the other.

00:44:21.255 --> 00:44:23.077
But you're too busy telling me, nine,

00:44:23.097 --> 00:44:23.838
seven, one, one, no,

00:44:23.878 --> 00:44:25.398
reimburse seventy-eight dollars.

00:44:25.539 --> 00:44:27.599
And I'm saying, I agree with you,

00:44:28.300 --> 00:44:30.181
but we need to aim further downfield.

00:44:30.742 --> 00:44:31.041
Right?

00:44:31.101 --> 00:44:32.083
Last inch is more money.

00:44:32.103 --> 00:44:32.623
A hundred percent.

00:44:32.943 --> 00:44:33.224
Yeah.

00:44:33.423 --> 00:44:34.304
A hundred percent.

00:44:34.625 --> 00:44:36.565
And, you know, we need to do

00:44:37.155 --> 00:44:39.416
a lot fewer things and go a lot

00:44:39.476 --> 00:44:41.197
deeper with the things that we do yeah

00:44:41.297 --> 00:44:44.519
inch wide mounting yeah absolutely and you

00:44:44.539 --> 00:44:47.722
know and another like trigger for me is

00:44:47.742 --> 00:44:49.282
that you know going to a pt clinic

00:44:49.302 --> 00:44:51.423
i'll see this therapist doing three sets

00:44:51.463 --> 00:44:54.346
of ten and i'm like tell me why

00:44:54.385 --> 00:44:57.126
that's important yep they're like what

00:44:57.168 --> 00:44:59.248
like the exercise no three sets of ten

00:44:59.389 --> 00:45:01.090
like why did you decide on three sets

00:45:01.130 --> 00:45:01.369
of ten

00:45:02.768 --> 00:45:04.288
And I seldom get an answer.

00:45:04.307 --> 00:45:05.588
They're like,

00:45:06.228 --> 00:45:07.409
I thought you were the specialist.

00:45:07.728 --> 00:45:07.969
Like,

00:45:08.009 --> 00:45:10.329
shouldn't there be a reason that we're,

00:45:10.409 --> 00:45:11.170
how much we're doing?

00:45:11.210 --> 00:45:12.250
Like we're dosing this.

00:45:12.990 --> 00:45:14.391
Like, what's the right dose?