You're listening to the P.T.
Pinecast,
where smart people in healthcare come to
make noise.
Here's your host, Jimmy McKay.
All right, ladies and gentlemen,
doing a quick Monday live stream because
there's some interesting things on
LinkedIn.
And when there are interesting things on
LinkedIn,
I like to point them out because there's
not always interesting things on LinkedIn.
Sometimes it's just a lot of, well, noise.
But I thought some good points were being
made by this guy right here,
Rob Panarella.
And I wanted to share them.
He had a post,
and I think he got such a good
response from it that he had a follow-up
post,
and then a follow-up to the follow-up
post.
which is always great.
Interesting conversations happening.
And this has been over the last couple
of weeks.
And before anybody tightens up,
I'm not here to take down somebody.
I think Rob brings up some really, really,
really good points.
But something is breaking in the
profession and how we talk to each other
about this.
Maybe you want to call it a generational
divide.
I don't know.
It keeps being framed as a work ethic
problem.
I don't think it's a work ethic problem.
This feels a little bit,
I know this is a podcast.
We're also doing a live stream.
I know it's a podcast and you can't,
but it feels finger waggy.
And I don't think it's a work ethic
problem.
And that's why I think we keep talking
past each other and not to each other
to find a solution.
In my opinion,
if we keep framing this as a work
ethic problem,
I'm going to use hyperbole here.
These kids today don't understand what
hard work is.
Back in my day, agreed, said that,
heard that.
Again,
if I don't think it's a work ethic
problem, then what is it, Jimmy?
I think it's a conversion problem.
Again, I think Chris Voss,
who's an FBI hostage negotiator,
would point this out and he would say,
one side of the argument is talking in
logic and the other is talking about
emotion and neither is better and neither
is right and neither is wrong.
How could that be?
Someone's gotta be right.
Let's walk through this.
First of all,
you have to know who these people are.
Rob has more than more than forty years
experience in the profession.
He's not theorizing the things he's
talking about and describing in terms of a
career path.
He actually lived.
He actually walked and he's written.
And here's I'm going to quote as much
as possible.
So I don't put words in anybody's mouth.
I have enough words in my mouth.
He said to achieve the professional and
financial success desired,
a physical therapist must provide value.
Don't disagree.
He continues,
founded upon an exceptional work ethic and
clinical knowledge and skill set exceeding
those of your peers.
That's true.
Historically, that worked.
The latter looked a little something like
this.
Would love for you to correct me if
I'm wrong.
Anybody listening or watching.
Get really good, produce great outcomes,
earn trust, build referrals,
gain leverage, see financial upside.
That ladder existed.
A lot of people climbed it.
Rob is one of them.
That's what it feels like.
So I'm trying to read into what Rob
said.
I don't disagree.
I think Rob is also very clear about
something that people keep misinterpreting
as well.
Rob says,
working hard was not implying to increase
the number of patients seen in a day.
I think that's a quote.
I think that's good news for everybody.
Rob defines hard work in this way.
Here's a quote,
working hard implies continuing education,
spending time with surgeons,
learning the business of physical therapy.
All the things I just said,
Bill value.
The question I think newer physical
therapists are asking isn't whether
everything Rob said creates value.
It's whether that value still converts
into upside predictably.
See how I'd pause for dramatic effect?
Because I think that's why I don't think
it's a hard work problem.
I think this is a conversion problem.
Let me give you a scenario that I
read often.
A new grad PT starts their first job,
ready to work hard.
Productivity expectations, let's say,
fourteen to sixteen patients a day.
Documentation bleeds into nights.
Student loan payments begin a few months
after graduating.
They're encouraged to get involved,
do some of that hard work.
Unpaid weekends,
we can call it what it is,
unpaid weekends, shadowing surgeons,
more courses.
while raises are modest and ownership
isn't really on the table a lot of
times.
Is this why we see a lot of
the single provider clinics popping up?
Spoiler alert, I believe so.
In my example there,
that new grad PT or that plucky PT
isn't avoiding effort.
They're asking a question.
They're trying to understand the return.
This goes back to my premise.
Is this a hard work problem or a
conversion problem?
The question I feel like we're being asked
is,
or that the new grad PT is asking,
if and when I become exceptional to what
Rob just said,
Who gets rewarded for that?
Now, keep in mind,
I like to look at similarities and
differences.
So Rob did this as well.
He brought it and we'll bring up an
Elon Musk reference later.
But let me bring up some parallels and
we'll see if they're similar or different.
Journalism went through this.
Retail went through this.
Tech is going through this now.
When professions move from apprenticeship
ladders to efficiency systems ladders,
excellence doesn't disappear,
but when professions move from these
ladders to efficiency systems,
it just stops converting well.
As in, hey, in my experience, work hard,
work nights,
work weekends at radio stations for little
to no pay.
Keep in mind,
I worked for several years with no pay.
I was okay with that because I saw
the ladder.
I saw the first rung that I was
on and I saw other people around me
who were one, two, fifteen steps ahead.
I understand this for that.
Quid pro quo.
Turns out studying Latin in journalism
school actually makes sense.
I think that's the shift people are
reacting to,
in that the latter isn't converting
anymore.
So they're not saying,
I don't want to work hard.
They're going to go,
I'm going to keep staying on rung one.
Why bother?
What's my citation?
People leaving the profession at mass.
So Rob is also direct about reimbursement,
which I agree.
Reimbursement rates will likely not
increase soon.
PTs are gonna have to work hard.
Here's where I'm gonna,
and I've invited Rob to talk about this.
I don't understand what that part means
because I think, I'll say it again,
reimbursement rates will likely not
increase soon.
Hard disagree, I'm sorry, hard agree,
agree.
Agree, agree, agree.
If you listen to our live streams with
Tony and Dave Kittle, it's not going to.
rob rob is actually kind reimbursement
rates will likely not increase soon i
would come in and go i will triple
down on rob what rob said they will
not increase soon or otherwise pretend
they're zero what if insurance could be
the loss leader that's a different
conversation here's my confusion about
rob's quote reimbursement rates will
likely not increase pts are going to have
to work hard agreed but that leads to
a fair follow-up question how
I don't think new grads or anybody,
I don't think it matters where you are
in your career.
I don't think physical therapists treating
clinicians are avoiding effort for the
most part.
I'd stand behind that.
I don't think they're avoiding effort.
I think they're questioning the return,
which is a thing I also hear many
people say, well,
then PT students need to understand,
become financially literate.
Get it economically literate.
When you sign on that dotted line to
take out your loan,
understand what you're committing to and
you pay back.
You pay back every nickel.
Agreed.
I think what they're doing here while they
work, they go,
so I'm going to do this.
I'm looking at the ladder and I don't
see many people on it and the people
that are aren't moving.
I don't think they're avoiding effort.
They're questioning the ROI.
That's not entitlement.
This is where I think an agreement,
the disagreement happens.
Right here.
This is the intersection.
That's not entitlement, everybody.
That's asking questions to become economic
literacy.
That's a path to it.
Hey, I'm going to do all this.
Good.
I'm okay with that.
And then I'm going to get...
We'll figure that out later.
Just...
anybody who says that to you run away
from that person when they clearly define
what you need to do and then says,
we'll figure out where this goes later.
I gotta be honest to me personally,
big red flag.
I think that's where the issue is.
Um, now we go into, uh,
a quote from Rob where he parallels this
similarly to what I did,
where I said journalism did this and
retail.
The examples in journalism, retail,
and tech, journalism was be an apprentice,
eat shit, make not a lot of money,
work hard,
but
We all did it and we all progressed.
Look, look around.
That person's been there for three years,
five years, seven years.
Now see where they are now.
Retail was the same way.
Fold shirts, bus tables, be a waiter,
become a manager, become a,
like there was a ladder.
But those systems don't operate that way
anymore.
Neither does PT, in my opinion.
Rob does something similar.
He references Elon Musk as an example of
what hard work can produce.
Extreme effort can lead to extreme
outcomes.
Here's the problem.
That's cherry picking.
That's a logical fallacy.
Outliers don't explain systems.
They obscure them.
Most PTs aren't trying to achieve the
thing that Elon Musk is trying to achieve.
They're not trying to become billionaires.
They're trying to build sustainable
careers.
So I think that parallel,
that one doesn't hold up.
I also don't think this is old PT
versus young PT.
I, again,
will reiterate the core of what I think
this is and is not.
I don't think it's a work ethic issue
versus entitlement.
One is logic, one is emotion.
See how Chris Voss,
the hostage negotiator would come in and
be like,
you guys are just gonna be two dogs
barking at each other and you're never
gonna solve this unless you actually
understand what the disconnect is.
Here's what I mean.
Here's where I agree with Rob.
Hard work didn't stop working.
the system stopped converting it into
upside consistently.
I think you need to ask yourself the
question, which forms of hard,
which forms of hard work still compound
and which ones are just extractive?
That in my opinion,
and I cannot speak for all of new
grad PTs, that is what they're asking.
I mean,
it's very confusing to me when people say
like these kids today don't want to work
hard or are they looking at what the
hard work is and downfield on what it
might bring and saying that math don't
math.
I can't speak for everybody that would be
disingenuous.
I feel like that's what it is.
I think Rob's experience matters a lot,
forty years.
And if you look at his resume and
I'll share his LinkedIn profile,
it's legit, man.
This guy's done the thing.
I also think new grad frustration matters
and what they're looking at.
I think their response is actually
appropriate.
How could both people in this scenario be
right?
It's because one's talking about logic and
the way something used to be,
and one is talking about how it is
now.
What does this matter?
My professor in PT school taught me
research, Jason Craig,
told me to look at things this way.
What, so what, now what?
I think the now what thing,
we're seeing that.
Professions don't lose talent when people
stop caring or working hard.
Nope.
They lose talent when effort and reward
drift too far apart.
You're asking smart people,
smart people to make a dumb decision and
you're confused when they just don't.
And then you blame the effort.
Isn't that funny?
Like you're talking about logic.
Hard work over time equals output,
but not in this system.
I don't know if anybody would disagree,
but I would implore you to.
And then in comes the new grad PT
using that logic saying, okay, show me.
Hard work over time equals ambiguity.
So if we want to keep great people
in physical therapy,
which it sounds like we do,
I don't know that there's much agreement
there.
We have to get honest about where effort
still creates leverage.
Because it's not where it used to be.
I'm going to say that again.
It's not where it used to be.
It's other places.
I agree with Rob there.
But that's where I think Rob's sentiments
and his view of things,
he's been doing it for forty years.
I think that is a strength,
but could also be a blind spot.
Because what worked forty years ago
doesn't always work now.
So I'm going to give Rob a question
list and I would love to hear his
thoughts on this.
I would love to hear yours because I
think we are like two dogs just barking
at each other.
When one side of the equation says,
these kids today don't work hard.
And the other side says,
but that work won't lead to anything I
value.
Notice how I keep using the same words
Rob did, which is good.
It's not just money.
I didn't go into radio to become Elon
Musk.
I wanted to get up out of bed
and love what I did.
But my first year out of college,
I made fifteen thousand dollars a year.
Sorry,
fifteen thousand five hundred dollars a
year in two thousand one.
As a broadcaster, loved it, loved it,
was OK with that until I did that
for two years and got promoted three times
in two years with no raise.
And then I was looking downfield.
oh, this isn't going to convert.
So I was that plucky young journalist,
that plucky young broadcaster who had to
do the nights and weekends,
sign up for sitting in the floats for
all the parades,
doing the things other people didn't wanna
do, fine.
I wasn't ever gonna be a billionaire,
also okay.
I was fine with it.
But when I started looking around saying,
oh,
this hard work isn't gonna move me up
the rung.
And when I was confronted with that math
equation,
I couldn't just go start a radio station
in two thousand and two.
You couldn't you couldn't do it.
So I opted out.
I worked from age eleven to age twenty
one to be a broadcaster, became that,
did it for two years,
did everything right to me as an air
quotes, did everything right.
And still had.
To ask myself that question,
if I keep doing this,
will the juice match the squeeze?
And the answer was no.
So I left.
I lucked out because on the way out
the door, I ran into someone who said,
I will reward that work and I will
show you how to do it.
So there are ways to do it.
But simply blaming someone for doing the
math and not liking the outcome,
I got to be honest, it's lazy.
if I channeled my own inner Chris Voss,
I would say,
understanding what logic and emotion the
other side is living in is probably a
good first step.
So I'll have Rob on.
I think we're, I mean,
he brings up a great point.
And I think the reason his posts caught
fire and got a lot of interaction is
because this is a really important issue
that we haven't figured out yet.
And I'm not here to say that I've
figured it out.
But from my perspective,
I feel like that might be one thing.
And I'll reiterate it again as I close.
My parting shot,
this isn't a work ethic problem.
Say that all day.
I think you're wrong.
It's a conversion problem.
And until you fix that conversion factor,
That's it for this one,
but we're just getting warmed up.
Smash follow, send it to a friend,
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pgpinecast.
And legally, none of this was advice.
It's for entertainment purposes only.
Bullshit!
See, Keith?
We read the script.
Happy now?