Thanks, Voice Guy.
First,
I want to say thanks to Brooks IHL.
If you're thinking residency, fellowship,
or just want deeper clinical mastery,
at least kick the tires.
Brooks IHL has programs that actually
shape better clinicians,
not just give you letters.
Everybody likes letters.
Letters are great.
But really, you want the other stuff.
I know what you want.
Brooksihl.org.
That's brooksihl.org.
Orthopedics, neuro, geriatrics,
pediatrics.
There's more.
I just don't have a list in front
of me.
And do,
in this tenth anniversary year of the
podcast,
who knew this would go more than ten
weeks?
Never mind a decade.
Brooks has been here for a couple years
supporting the show.
So thanks, Brooks.
Brooksihl.org.
Today's guest...
spent nearly a decade, also a decade,
a decade, a decade,
working with patients who challenged the
norms of recovery and rehabilitation.
But somewhere along the way,
she realized it wasn't just the patients
who needed new ways to move.
It was the profession itself.
It was us.
The call was coming from inside the house.
Now she's on a mission to flip the
script in neurologic physical therapy,
building a movement, a business,
and a mindset that says we don't have
to wait for someone else to fix it.
Spoiler alert.
No one's going to fix it.
We either fix it or it falls apart.
We all know that.
She's changing the game for clinicians who
want more than burnout and low-ball
paychecks.
I love this.
Let's get into the studio.
Lauren Young,
you mentioned spicy and salty before we
got started.
I was like, yeah,
and we could tell with that intro.
We're bringing a little salt.
Yeah, we're here.
Jimmy,
it's funny that you say it's been ten
years because I'm pretty sure I've been
listening to your podcast from the
origins.
Really?
Well, when did you, all right,
so I always love this.
This is not scripted, nothing scripted.
How did you,
do you remember how you found the show
and where were you in school?
Like where were you in your life?
I was early,
early career clinician whenever I found
out.
When did you graduate?
I was twenty sixteen.
Me too.
Yeah.
So I was working and I don't it
had to be something that like the APTA
put out.
And if you were a part of it,
I don't remember.
And I've been trying to remember.
But I remember very vividly listening to
your podcast.
And I can tell you,
I don't know what episode,
I don't know where, but you said,
the problem is we are salespeople,
but we are not doing a good job
selling.
And in that moment, I was like,
light on.
So I will tell you,
I thought all these years of listening to
your podcast was like, man,
if I make it on that podcast,
I will have made it.
And here I am.
And here we are the pioneer of
I mean,
you were really the first one in this
space talking about the things that people
didn't want to talk about.
And I whispered them.
They whispered them or said them without
putting their name on them at happy hours.
This is why I'll podcast like, you know,
I don't drink a beer in every episode
anymore.
I did at one point drink a beer
in every episode.
You know,
my waistline would appreciate that.
We'll do it in person.
But what I kept seeing was there was
two reasons.
I think I started this.
I sat in a room full of a
thousand people watching a person give a
presentation that I was like,
this is cool,
but I don't get all of it and
met the person after in the bar and
it was a totally different person and the
words and the vibe was different.
And I was like,
you're just as brilliant here
but I didn't understand you on stage.
Why did you do that?
Do this there.
And then the other thing was that,
which is like, we all complain.
Like I'm going to Graham sessions in a
couple of weeks.
Do you know what Graham sessions are?
A lot of people don't.
I didn't know.
It's like an invite only thing.
It's only one hundred fifty people and
it's meant to be.
And I'm not knocking the reasoning behind
it.
But it's meant to like, well,
we talk about it and we can talk
about whatever we want,
but nobody pays repercussions.
And I'm like, but then there's no stakes.
There's no tension.
If there's no tension, I start off.
I didn't expect this to go this way,
but we'll keep going.
Whenever I'm working with someone,
doesn't matter what.
If it's a company, right?
I'm sitting in front of three people and
they're like,
maybe we want to work together,
do a project.
I go, one of my go-to questions,
which is great for clinical care,
what happens if we do nothing in six
months?
And people are like, what do you mean?
Well, you've done nothing for a while.
What happens if we do nothing for six
more months?
What I'm doing is I want them to
envision the stakes.
What fails?
What doesn't grow?
What does that feel like?
Are we still pissed?
What happens if I don't do my dishes
for another day because I live alone?
I have to walk by them and they
smell and then I feel even worse.
And then there's more dishes because I
have to keep eating.
And that's the only way to get me
to do anything.
The other good question I like is,
if this doesn't get fixed,
or if we proceed with option A, B,
or C, and it fails, who's in trouble?
And I don't say that to be like,
let's point blame.
That doesn't help.
What I mean is like,
who's going to own this and champion this
with me?
Not fight me, but it's like,
who gets in trouble?
Because if five people... First of all,
if you can't answer that, and you're like,
well, us and this and it's not...
No one owns it,
so they won't get in trouble.
And if five people own it, same thing.
won't change.
And what's the trouble, right?
Like, I see identify the trouble PT world,
we all think,
like the highest stake is like losing the
license,
I'm in a clinic where I just opened,
you know,
I have this setup that I'm okay,
if it fails,
I don't think it's going to fail.
I'm not intending for it to fail,
but like,
I'm not going to lose my license if
it fails.
Like, what do I actually lose?
And I think people don't delve into that
question enough.
And so they are just paralyzed by fear
because they don't realize what it is that
I'm losing.
Really,
it might be six months of my life
and I've learned a lot doing this.
So have I really lost even if it
doesn't work out?
No,
I've learned a ton that I would take
back into a different clinic with me.
This is a sports analogy,
but it still works,
which is there's a difference between
playing to win and playing not to lose.
Did you play sports?
Were you an athlete, former athlete?
High school, but yeah.
But what sports?
I can use that analogy.
What sport?
Yeah, it's softball.
Yeah, like it's funny.
I played baseball and softball and all of
a sudden you're up by six and one
run goes in and you're like, well,
we're up by five.
So let's just get this.
Like,
let's just be safe and keep the ball.
It's like next thing you know,
you're down by two and you're like,
what happened?
Where did it go?
That's playing not to lose instead of
like, I need to win now.
Pretend like it's tied.
Pretend like we're down one.
You know,
I play old man beer league hockey now
and we'll be sitting on the bench.
And I just quote, like,
I don't even know where it came from.
Probably watching some game on TV.
And they were like, oh,
we're up to two goal lead.
Worst lead in hockey.
Why?
Because you're comfortable.
Because you're comfortable and you're
like, well, I just, I won't push.
It's like,
you have to act as if it matters.
Not act as if I got to throw
ten Hail Marys and risk losing everything,
but act as if what I'm doing is
going to affect what happens three, six,
nine, twelve months from now.
And I think that's part of the
I don't want to say issue,
but issue with our profession is
everyone's comfortable.
We're all comfortable.
We have a system.
It sort of works depending on who you
talk to.
I don't think it works great,
but it does what it's intended to do,
but then that's the baseline.
And I think we have the ability to
do so much more,
but so many people come out of school.
You've got debt, all of these things.
We go into a clinic,
we start the nine to five,
we see twenty four patients a day.
And by year five,
we're burned out because we were
comfortable.
Did you see the movie?
It was George Clooney up in the air
where he's the guy who flies around and
fires people.
So his job is you,
a company hires him to go around the
country and like do layoffs.
He's the guy who sits in the room.
You get called into his office.
He's the grim reaper.
And who's the guy from Whiplash?
Remember the movie about the drummer?
I'm a terrible movie person.
But it's that guy.
The guy is getting fired.
So George Clooney is sitting across.
Someone's yelling it right now at the
speakers.
Like, how come you don't know this?
And he's sitting across and he's looking
and he's firing this guy.
And the guy's like in his sixties.
And he's looking at this guy's resume and
he goes, hey man,
I saw on your resume,
like you went to the Culinary Institute
and now you work here at XYZ Cubicle.
And then George Clooney said,
because this guy's pissed.
He's like, you guys are firing me?
I've worked here for twenty five years.
And Clooney's like, it's not me.
But he looks at him and he goes,
how much did they pay you to first?
How much did they pay to give up
your dream?
And then the guy stops and he takes
a breath and he said,
like twenty three thousand dollars,
twenty three thousand five hundred dollars
in health insurance.
And that was twenty five years ago.
And it's like, you came,
you didn't come this far to come this
far.
Like,
and I'm not saying cash out your four
Oh one K and just throw,
just wing it.
That's not what I'm saying.
What I'm saying is like what you do
now will come about three, six, nine,
twelve from now.
If you do something now,
we say this to patients all the time
and then we don't do it.
So you said PTs need to stop being
bleeding hearts.
I say Peace Corps gene.
You say bleeding hearts.
Pretty much same thing.
What do you mean by that?
And then what do we need to do
instead?
I think that in school,
because I've done a lot of thinking about
this, because I've run,
I just in October put my application in
to be only Medicare.
Like I'm only accepting Medicare as an
insurance.
And that's a lot of.
Maybe before we get into this,
give people the setup so they understand
where you're coming from and where you
are.
Yeah,
so I worked in clinic-based settings
across the continuum of care for seven-ish
years, full-time.
I'm in academia now while running.
It was a cash-based clinic,
now starting in network with Medicare.
A lot of that is because of the
rules that we have that we can't,
as physical therapists,
opt out of Medicare.
So you really don't have a choice if
you want to see that patient population.
um and a lot of neuro folks that
i'm a neuro clinical specialist i should
probably say that too um a lot of
neuro folks are medicare beneficiaries so
um you know it's kind of from a
business perspective you i had to i didn't
really have a choice um so now i've
got i was doing mobile um out of
network and i opened up a clinic and
so essentially looking at all of this
You say I've heard the conversation that
trying to charge cash for something that
Medicare or that insurance covers is
unethical.
We shouldn't do this.
Like, where is the tipping point?
But then I look and see massage
therapists, chiropractors,
personal trainers, exercise physiologists,
you name it.
they're charging cash for their service
that, you know,
I'm not going to say is exactly the
same as ours,
but there is some overlap at some points
where we're all doing very similar things.
And so if people are willing to pay
those practitioners,
I think that we are doing the profession
and ourselves a disservice as physical
therapists by being a bleeding heart and
saying, well, no, no, no,
let me figure out a way so you
can use your insurance.
When these people are coming to you and
saying,
I'm happy to pay you out of pocket.
So that's what I mean by bleeding heart.
I think we need a little more business
knowledge, not a little,
a lot more business knowledge in our PT
schools.
Even if you're going to go work for
someone else,
understanding this is how you can maximize
billing.
I can tell you for seven years of
my career,
I charged an eval and that's it.
That's crazy.
I should have been charging therapeutic
activity because I spent fifteen minutes
explaining a home exercise program or
teaching how the proper way to move them
from the bed to wherever.
But it was never presented to me in
a business manner of here's what you're
doing.
Here's how you do it.
In a way to to make revenue,
because that's where this all goes is I
feel like we are.
pushing the profession to a point where
it's not gonna be sustainable.
Because we are such bleeding hearts,
patients aren't gonna have a place to go
because there's not going to be a business
to sustain that.
I've used this before and I can't remember
who I stole it from,
which was like the lifeboat analogy.
If you have a lifeboat and it says
this lifeboat will hold one thousand
pounds and you've got ten people that are
all one hundred pounds.
I don't know who these people are.
They're all one hundred pounds,
but I'm not good with math.
And there's one more person in the water
and you pull them in.
You all sink.
I nobody wants to leave most people.
Most people don't want to leave an extra
person in the water.
Right.
Ninety nine percent of all PTs would opt
to bring that person in the water or
sorry, in the boat.
But then we like if the clinic goes
down, we help no one.
So we need how do we scrub this
from our DNA?
How do we get the Peace Corps gene
out of it without losing the heart?
Yeah.
Which is and again,
Lauren, myself,
most people are not asking you or telling
you to do anything unethical.
We're asking you to understand how gravity
works and sunlight and physics and
understand the physics of what you're
talking about.
But here's a question,
but it's almost rhetorical, but like,
where do you put this in PT school?
Is this a hot topic?
weekend?
Is this a day?
Is this sprinkled throughout?
We've got, I mean,
what do you take out?
We've got, you know,
you getting hit with a fire hose.
I don't know the answer because I'm not
an academic.
I'm going to stop talking about academic
things because I haven't been in it.
So I can't speak on that behalf.
No, I think that you're right, though.
I mean,
the program that I teach in is
accelerated.
Our students are getting their doctorate
in two years.
So you talk about firehose of traditional
PT program and now you've accelerated it.
And I think, you know,
even in PT school,
would I have been receptive to this?
Would I have had the context to then
understand?
what is trying to be said to me
when I haven't gone out and build.
I mean, like I said,
I was seven years in and I was
angry when my clinic was like,
we're gonna stop buying in the really good
E-Stim pads and we're gonna buy the E-Stim
pads that work,
but they're not top of the line.
I was like, this is ridiculous.
And now looking back, I'm like, oh,
I see, I understand.
So I think for me,
my clinic giving me that information and
saying,
because I'm looking at hiring someone to
come in and help me.
what I said is if we understand this
to the point where we can maximize our
billing, again, like you said,
without being unethical,
without totally being soulless,
because I'm not,
I got in this to help people,
but I also see, again,
we have to make this sustainable to be
able to continue to help people.
If we can maximize our billing and
maximize our time and maybe pick up other
sources of revenue,
then
I can pay you more.
But we have these students who are coming
out of school and they want a hundred
thousand dollars.
your clinic's not making a hundred
thousand dollars.
How do you expect them to pay you
that?
You know,
if you're willing to come in and say,
I have these six ideas that I think
we could maximize billing in this way,
and we could be a hybrid and I'll
run this extra class three days a week
after hours or whatever,
now pay me more money.
Okay.
Let's talk.
But I think that
it's clinic owners too.
And I'm really talking because you look at
some of these big private equity groups,
it's volume, right?
They can take that low contract because
they're willing to put their therapist
seeing twenty, thirty people a day,
which is crazy to me.
I've only worked in places that I see
one patient an hour,
but it is a little different in neuro.
But, you know,
it's these smaller clinics that are
getting taken out of
essentially our economic chain because
they can't keep up with the low contract
rates that other larger companies are
acquiring because they have the volume to
do so.
But then we're losing.
We're losing wonderful clinicians because
they're tired.
In what other profession does someone go
get a doctorate degree and within five
years is burned out and leaves the
profession?
Yeah, I mean,
I was listening to a talk on burnout
every day and I don't disagree that it's
there.
I felt it.
Why does it come about?
This could be its own series.
I could do an entire week of things
like this, right?
But if I feel like I'm getting taken
advantage of,
That is like a rock in my...
A pebble in my shoe every step.
So burnout doesn't come like a...
I touch the hot stove and there's a
scar.
It's like it's small and a pebble in
every step until it's this thing that
won't heal.
You mentioned somewhere...
That feels like it's opposite.
It feels like when someone says cash-based
something, it's orthopedics.
Why do you think cash...
These two terms feel like they don't
puzzle piece together ever.
Cash-based neuro.
This goes like soulless.
I'm using air quotes here.
Cash.
And then all of the hearts and feels,
neuro.
It feels like those two things don't go
together.
But...
They did, obviously.
You put them together.
Why do you feel like those two things
together get so much pushback,
especially from inside the profession?
up.
I think there's a lot of reasons.
I think one big reason that PTs feel
this way is because,
and I do think that there is a
shift.
I've talked to people on social media and,
you know, kind of across the country.
I do think there's a shift people are
seeing.
I think the big piece is, you know,
a neurologic injury, spinal cord injury,
brain injury, stroke, they're not cheap.
And so there are so many other medical
factors that are coming into play.
The
Other thing that I think why it works,
what I'm doing, and again,
I like to be very transparent.
I'm a low volume clinic.
want forty patients per week because I
can't give everything that I need to give.
You know,
I'll leave a patient's house and I might
make two hours of phone calls getting
wheelchairs ready, getting DME splints,
getting bath equipment coordinated with
other departments in the state.
You know,
doing that forty hours a week,
then I'm back to where I was seven
years ago.
And I was like, I'm done.
I will go work at Lululemon.
I'm finished being a PT.
And so I think
where my clinic's vision initially was is
that there is a subset of people who
get discharged from insurance,
from physical therapy, sorry,
from physical therapy because of insurance
limitations, you know, lack of progress,
whatever it may be,
who still want care because it's twelve
weeks of neurologic specific physical
therapy
isn't getting most people back to where
they want to be so what we're seeing
is a lot of people coming into that
space what mine has evolved into is people
who want more frequency so i'll have
people who see their you know
insurance-based therapist two or three
days a week and then they see me
the other one or two days a week
and then they're getting four to five days
a week of therapy and we know what
that means for neuroplasticity
But they don't have the bill that comes
along with an out of network therapist for
five days a week.
So again, it's creating a model.
And what I try and tell people is
like, what is your quality of life worth?
You know, if your quality of life is,
is worth what insurance is going to pay.
then that's fine.
That's your choice.
But if you want more,
insurance isn't going to cover everything
that you need, nor, you know,
does it always.
We always have, and too,
we can get into a lot of these
places, you know,
it might take an hour to get this
person out of bed, dressed, ready to go.
Then you've got a
You know,
an out of network therapist is going to
cost.
And for me, I come to your home.
So now all that travel and everything
isn't isn't there anymore.
So I think you're right.
It's not done.
And there's a few.
So so part of the bleeding heart issue
is part of it.
The other part is the Medicare issue.
You know,
we can't opt out of Medicare if I
go in and say.
you're a Medicare beneficiary,
I'm going to do an evaluation on you
and it's two hundred dollars.
I've just committed fraud and I have legal
risks.
So you can't do it.
And that's a whole nother conversation
that could take up more time.
But that being said,
I think that those are two big reasons
of why you're not seeing this as much.
But it's coming.
I really think that it's coming.
Have you ever heard of next step,
next step fitness?
So I met Yanni Corey who founded that,
you know, and I, you know,
I was just thinking, I was like,
I haven't had Yanni on the show in
a couple of years.
He hates the system, but loves PTs.
And then he's like,
I've taken heat from PTs because he sets
up essentially next step fitness is like
Yanni got injured.
went through PT.
It wasn't enough, right?
The insurance didn't cover what he needed.
He was at least financially able to go
get that.
He's like, dude,
I was in the point one percent who
was able to fly to Kentucky and live
there and work with this really advanced
neuro PT for months.
Who can do that?
So his next step is essentially he wants
to set up gyms
that have the right equipment that people
pay membership to be at.
But he's like,
I have to leave PTs out of the
equation because they're too expensive.
But he's like, I want their brain,
but I can't pay for this.
And he's right that math doesn't math.
So what he does is he brings PTs
into train trainers.
to make sure that they're,
they're understanding.
And like, I'm like, but here's the point.
If PTs don't like that,
it's like people are still getting great
care and a PT touched them one degree
removed.
So it's like Yanni was like,
I'm not going to stand here yelling at
clouds.
I'm just going to fix,
I'm going to create something.
I,
he had to create his own solution and
he did.
You can't fault someone for that.
No.
And is he based out of Kansas city?
He is based at a, he probably,
his goal is to have one of these
at least in every state.
So he's out of California.
I know that,
but I think he has one in Kansas.
Yeah, here it is.
LA, Atlanta, Kansas City, Orlando,
Raleigh, Vegas, Pittsburgh, New Zealand,
Ukraine.
So those are all the locations.
Wow.
I've got, so I've got two,
I've lived in Kansas City.
I've got two former patients who go there
and they love it.
They've been going there for, I mean,
I've been gone from Kansas City for almost
four or five years.
They've been going there that long.
And, you know, like you said,
I think that's the big piece of it
is they have the equipment.
Yes, that's the FBS bike.
They've got the arc X that's now come
out standing frames, the excite.
I mean,
every piece of equipment and at least the
one in Kansas City is it does all
diagnoses,
but it's really specialized to spinal cord
injury.
um and so it's like you know these
things are pieces of equipment i mean the
arcx is forty thousand dollars like you
know but they have it and again it's
it's based on a cash pay rate it's
someone else who found people will pay you
if you show up so you know at
that point
Why aren't we doing more of this?
And I totally agree.
I think people are much more willing to
pay a trainer,
fifty to seventy dollars an hour than they
are to pay a PT,
one hundred and twenty five,
whether you're going to get better or
different care from either one.
At some point, the cost is the problem.
So how do we fix that?
Well, we now hire those personal trainers.
We oversee what's happening.
I mean, eventually in my mind,
that's where I want this to head is
that I want to oversee personal trainers
who are willing to work with this
population because it's a very niche
population.
Personal trainers can go out and work with
anyone who is an able-bodied individual.
You bring in someone who's swinging at you
mid-session or crying mid-session or has
bones that are super brittle because they
haven't stood or walked in years.
It could be a recipe for disaster if
it's not properly supervised.
So I do think that...
There's got to be a way that we
can all play nice in the sandbox,
but there's just a very big divide between
that model right now.
I said you could be mad.
You could be as mad as you want.
at the situation,
but don't be mad at someone else for
solving the problem that they're stuck in.
Yanni's in a chair, man.
And so the only way to get better
was to quite literally chart his own
course.
He's nice enough to not, I mean,
he could have just bought all this stuff
himself or just solved his own problem.
He now takes his time, his effort, his,
you know, his energy,
and he tries to solve it.
And again, ambitious goal.
He's like,
I want one of these in every state,
in every major city.
And the fact that he's the only one
should, you know, anger people.
Right.
So look him up.
I'll give the next step fitness.org.
Just look into it.
If it's in the city, go tour it.
Yeah.
Yanni's the first guy who go come in
here,
steal everything I'm doing and go do it
somewhere else.
He's the first guy.
He'll show you how to do it.
I bet.
You mentioned,
you mentioned being in academics.
You've called out or mentioned how,
how does PT education misses its Mark?
If you were building a,
a PT program, dry erase board, blank,
what would you change?
Oh, man.
Stop, start, continue.
What would you stop doing?
Start doing, continue.
What does it look like?
Or what's your one or two suggestions if
you had a magic wand?
If I had a magic wand,
I would put everyone who is in academia
back in the clinic and learning about
what the billing is,
what the AI is doing right now,
what does a typical day for a physical
therapist look like in your average PT
clinic?
That would be thing number one.
Not just our four hours or our eight
hours that are given to us in our
contract.
The other thing is,
and I think it kind of rolls off
of that,
is things are changing and PT school
education just isn't keeping up.
So I think...
The hands of time moves slowly in
academia,
and I think that just and I work
for a very progressive program.
That's the kind of crazy thing,
but there's other.
factors at play that you really have to
stay within the constraints of the
academic system.
So even though you might be as progressive
as you want to be, I mean,
they're a two-year program and they
started this ten years ago.
You know, when you start this,
you can be progressive,
but you still have constraints that you
have to monitor.
So I think putting people in the clinic,
one thing that comes to mind is like
documentation.
We spend time, you know,
grading, soap notes,
and all of these things.
And I'm like, man,
AI is doing most of this now.
And then I took Tony Meritato's course,
Zero to Paid.
And he's like,
you know what Medicare requires for a
certified plan of care?
Here's your three things.
And I'm like,
why are we in school teaching students
that they have to write this novel
when one AI will do it for you,
which granted,
I'm not saying like you have to go
and you have to check it, right?
I'm not saying we use AI unchecked,
but we're using AI and Medicare doesn't
require this novel.
So why are we writing one?
Somebody did an analysis years ago by
APTA.
We were over-documenting by a crazy double
digit percentage and under-billing by a
crazy double digit percentage and then
saying we're overworked and underpaid.
the calls coming from inside the house.
The writing is on the wall.
Yeah, and that's the thing is like again,
it all goes back to we have to
have educators who are educated in what's
coming next and what's what's happening.
And then we have to have a system
who's willing to make these changes.
And it's not just like this cool feature
in a course.
It's like this is how PT is is
evolving and how it's going.
You know, I've talked.
Generally, with a friend, they own like,
fifteen PT clinics and he's always
approached me.
He's like, let's start our own PT school.
I'm like, no, no, no,
we don't need to do that.
But what we've talked about is how do
you make something that's specialized to
where if you're ready to run,
if you know you're going to open a
clinic, you start.
It's a dual program.
It's an MBA or a master's in health
administration,
something dual enrolling with PT and you
come out and you're ready to go because.
this journey of opening a clinic and just
figuring out what are the rules,
what can you do, what can't you do,
has been just completely eye-opening.
At some points I'm like,
where do you even learn this?
I've called people,
I've had to use resources because it's
like a secret club.
It's like the Graham session sometimes.
That's how I feel.
If you don't know a mentor in the
field,
that's already done this who can help you?
Where do you go?
Where is the magic bullet of information
that says, here's how you open a clinic?
It's everywhere and nowhere.
It's like you don't need permission,
but you also need guide rails,
but you could figure it out.
But not everybody has the money, the time,
or the risk tolerance.
We need more people to do it,
but whose job is it to help?
It's everybody's job,
but it's nobody's job.
Who gets in trouble if we don't do
this, and who's going to help us?
Before I forget,
I'll say thanks to Empower EMR,
the platform helping clinics simplify
documentation, improve patient engagement,
and get their time back.
EMR doesn't have to be painful.
That's a choice,
as long as you pick the right one.
And who knows if Empower EMR is the
right one for you?
They understand there's a cost involved in
change.
So go just talk to Sharif there.
EmpowerEMR.com.
It's EmpowerEMR.
You've mentioned being considered a
graduate degree versus a professional
degree before.
I think that's,
we started talking about that.
That's the thing that was all the rage
and we were signing petitions and we were
going to March,
March in Washington on this.
How dare you?
And I was like, you know,
this is where I liked hanging out with
Tony.
He's a lot.
He's like,
did anything change besides a word in a
book?
It didn't matter anyway.
Yeah.
To begin with?
Correct.
That was the thing.
When someone pointed that out,
I didn't know.
They're like,
we didn't have the designation.
It was sort of like we were on
double secret probation.
We were like allowed to, but weren't.
And then it was taken away.
I was like,
this is like when you're in sales and
you're like, I lost the sale.
It's like, did you have the sale?
How'd you lose it?
You didn't have it.
It was never yours.
Don't feel bad.
So why was that?
I feel like,
why was that a distraction important for
the future?
Maybe, I guess,
maybe it got our attention at least.
that was it was nuts because it was
like okay there were rumblings and then it
got a little louder so you saw a
few people start talking about it and then
all of a sudden all of social media
was doing the well if i'm not considered
professional anymore like whatever and i'm
like wait
to be clear,
we were never considered professional.
We didn't get anything taken from us.
We just didn't get added to the list.
But I think this is a really important
because, you know,
I have my own I have my own
thoughts.
I don't know that I have a strong
opinion either way,
which I think is kind of shocking for
some people,
because I can be very passionate about
things when I'm ready.
But I think the cost of tuition,
when you look at our return on investment,
is terrible.
So something needs to change so we can,
you know, have a better quality of life,
essentially.
I mean,
there's people who are working three jobs
to pay their student loans off.
And that's, again, why are we burned out?
Because you're working nine to five,
five to nine, and then on the weekends,
like you have no life.
So I think like that's part of the
equation.
But again, I don't
I think it could be good.
I think it could be really bad where
nothing changes and there's no more PTs
because they can't afford to go to school.
Obviously, that scenario is not great.
We're seeing it in education.
I don't know about where you live,
but where I live,
a lot of my friends were teachers, right?
And I remember when people my age,
so people born in the late seventies,
eighties,
to get a job in education in where
i live in new york or long island
you had to know someone to know someone
my grandma's neighbor is the school super
like you had to to get any job
never mind the subject or the age you
wanted to teach didn't matter now
I think they're just driving around
handing out teaching positions.
Why?
Because they made it a horrible thing.
And now no one...
And I mentioned this to someone else.
Even if you made it great tomorrow,
you're going to have to wait a few
years for those high school kids to
graduate,
go through a couple years of school and
come out and then start.
We're not seeing...
I feel like we're waiting for... We heard,
we saw the lightning.
We haven't felt the thunder yet.
Yep.
And that's what I feel like only time's
going to tell with this decision, right?
Is like,
is it going to be a good thing?
Is it going to be a bad thing?
Because it's going to happen either way.
So what do we do?
And I think, you know, like I said,
it was all the rage and then it
kind of fizzled out.
And again,
it'll come back around when we start to
see changes or things change.
in this nature, but I don't, again,
like I said,
I don't know how I personally feel.
And I put a lot of stuff out
on my social media and I'm like,
you know,
if you're called and you feel like you
wanna petition,
the APTA has very strongly said, you know,
that they're against this,
which makes sense because there could be
potential really not great impacts in the
profession.
And I see that.
I'm gonna have to rewind.
Did I just say we heard lightning?
Did you?
Probably.
So someone's probably going,
who is this guy?
Sure you can.
All right.
So you're clearly passionate about
changing stuff that you're passionate
about.
What's one step for a PT in your
mind who feels stuck in the old model?
Not not fifteen.
Fifteen is too many.
We know this with exercises,
but we should also know this with
professional steps.
Give them one and you got a chance.
Give them ten and you got no chance.
What's one step for a PT who feels
stuck in the old model and wants to
break free?
What advice would you give them?
I would say go start an LLC.
It takes, in most states, a hundred bucks.
Go start your LLC.
And I'm a big believer when I started
this.
I mean,
some days I still don't know what I'm
doing.
But when I started this,
I really didn't know what I was doing.
I'm a...
big,
big believer in feel the fear and do
it anyways.
And so I was terrified.
I'm like, I don't know what I'm doing,
but I started by saying,
this is my business name.
And from there I had somebody,
I was here, well, I started my business.
I maybe had had it for a month
and I had a PT clinic reach out
to me and they were like,
we want you to come work for us
and do this cash-based stuff out of our
clinic.
And like I got this feeling inside of
me and I was like, oh, no,
this is like my my brand.
This is my thing.
I'm really proud of it.
And it was very easy to be like,
oh,
I know you're offering me more money than
what this is going to make,
but I'm not interested.
And in that moment,
I realized like how much this meant to
me.
And so I think if you start your
LLC.
And you're kind of.
like protective of it and then from there
you take steps when you have something
legal that protects you you have your
insurance in place now when that patient
says hey do you see people on the
side you can say yeah i sure do
um i'm actually working uh with someone
and we're
We're hoping to start a cohort in April
that talks you through how do you create
a side hustle?
Because for a lot of people,
they don't want out of their nine to
five job.
But if you can slowly make that transition
into seeing three or four extra patients a
week,
Maybe you don't have to go work that
PRN job eight hours a day on Saturday
or Sunday or go to the nursing home
for three hours every evening after work.
And now it becomes you making the full
amount of money instead of giving part of
it to someone else.
So that's my advice is like,
just do it.
Do the thing.
If it sits there for two years, whatever.
You did it.
You took a step.
Good.
Okay.
Are you ready to play a game?
I've got a game.
You ready to play a game?
It must be my internet.
We're going to play a quick game.
You ready for a quick game?
Ready for a quick game.
Okay.
We're going to do clinical rebel or
business boss.
I'm going to throw a few situations your
way.
You tell me,
does this make you a clinical rebel or
a business boss or both?
And then just give me like a half
a sentence.
Why?
Um,
you charge out of pocket for high value
neuroservices.
Are you a clinical rebel or a business
boss or both?
Yeah.
Why?
I think that you have to value your
skills.
It doesn't value your skills.
Yeah.
You create an online course for PTs that
isn't CEU approved.
but it's still valuable.
Business boss.
Yeah.
A hundred percent.
I, I, when I started,
I've done a couple of courses and I
thought that you had to do it.
And then I was like, you know what?
You're going to get that for three hundred
bucks from Medbridge anyway.
Like,
so you're here to learn stuff or for
the little number at the end, whatever.
Send it into your state.
You can get it.
Yeah.
You say no to an insurance contract that
underpays.
Are you a clinical rebel or a business
boss or both?
Business boss.
Listen, as soon as you sign,
you can't complain.
You have waived your right to complain
because you signed the contract.
You bring on a student intern but have
them help with your social media strategy.
Are you a clinical rebel or business boss
or both?
I would say maybe business boss.
Could be both because it could be clinical
content too.
could be and it's i guess what's the
purpose is your purpose to build your
brand if the purpose is to build your
brand business boss is your purpose is for
education clinical there's a both uh final
question you tell a patient you need more
than what insurance will cover and i can
help you outside of it oh i think
clinical rebel and business boss love it
all right you're off the hot seat last
thing we do on the episode is called
the parting shot
This is the parting shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
pressure just your legacy i'm aligned uh
but it's brought to you by u.s physical
therapy building great pt clinics and
great pt careers across the country
usph.com they've got a lot of them you'll
be hearing from them on this show in
twenty twenty six and beyond usph.com so
parting shot lauren waiting for a decade
for this no pressure whatsoever what are
you gonna leave with the audience leave
the audience with today um you have to
be the pt that you would want treating
your parents
whether that's in business in clinical in
all of the things you have to want
what is best for the person in front
of you and that is and sometimes you
need to make a business decision so you
can exist long enough to help the person
three five seven years in advance
otherwise your heart can bleed all you
want but if you ain't in business you
ain't helping anybody if you're not a pt
anymore because you got burned out by the
system then all of that help and love
that you have is gone
No margin, no mission.
Lauren, where can people find you?
Where, what's the,
I'll put it in the show notes and
everything,
but where would you want people?
What's like the one or two places you
want people to go if they were like,
yeah, I want to learn more.
Yeah, go follow me on Instagram.
It's at neuro elite PT.
That's going to be the best place to
find me.
I'm happy to answer messages, questions.
I think the biggest thing about PT is
we have to be a community and help
each other and lift each other up because
we're all struggling.
We all feel very similarly.
So that's the place to do it.
Love it.
Lauren, appreciate the time.
Thank you for doing this.
Thanks, Jimmy.
That's it for this one,
but we're just getting warmed up.
Smash follow, send it to a friend,
or crank up the next episode.
Want to go deeper?
Hit us at pgpinecast.com.
Or find us on YouTube and socials at
pgpinecast.
And legally, none of this was advice.
It's for entertainment purposes only.
See, Keith?
We read the script.
Happy now?