You're listening to the P.T.
Pinecast,
where smart people in healthcare come to
make noise.
Here's your host, Jimmy McKay.
Here's your host, Jimmy McKay,
still pushing buttons as we go live.
And we're live.
There we are.
Sky Donovan, Mike Ring,
welcome to your live stream from Graham
Sessions.
Thanks, Jimmy.
This is your first Graham Sessions?
It is, yeah.
This is your first?
My first.
Look at this.
Very odd to me.
That's weird.
Because you're very elbow-rubby in APTA.
But I don't own a private practice.
Oh, that's a good point.
Yeah, but you're a big thinker.
I like to think I think.
I think you're right.
We're going very Dr. Seuss here.
All right.
Yeah.
So that is a good point.
I just see I know you're in academics,
but to me,
you're sort of everywhere in PT.
But Mike, background,
back of the baseball card.
How long you own your practice?
Sixteen years.
Yeah.
Sixteen years.
Good for you.
Our second location, actually,
December four.
Can you see it from here?
You can't quite close.
It's not close enough to see.
Close enough.
All right, so why'd you come?
How was this framed for you as a
practice owner?
I was thinking about this.
A lot of practice owners in there.
Leaving a practice for a day is hard.
Your business is going on.
So how was this framed for you to
come to something like this?
What did you expect,
and then what has been delivered?
To be honest,
this was the first time I knew this
existed.
I literally had no idea that Graham
Sessions was a thing.
I got an email from private practice
section.
And so I don't know if it was
because I was at the past couple of
PPS meetings or how I got on the
list, but I did.
I looked at the content.
I was like, actually, you know what?
That's kind of cool.
And it actually worked out great because I
don't see patients on Friday anyway.
Jackpot.
And then Sky, APJ vice president,
you get brought to lots of different
things in the corner of PT.
Being in PT for a long time, right,
in the profession.
Are you calling me old?
No.
Walked right into that one.
Good.
But no,
you've been in PT for how long?
Been around a long time.
Uh, not as long as you think.
Orthopedics, academics?
Yeah, I mean,
I've been a PT since two thousand three.
Okay.
So twenty three years.
So, uh,
what were you expecting and what are you
seeing from, I mean, you're like,
you're sort of like the down the middle
person this is designed for and you're
not,
which means you're both going to look at
what is going on here differently.
So what did you expect was going to
happen?
What did I expect was going to happen
has happened,
was that I was going to hear totally
different perspectives than I usually
hear.
So I love conferences like this because
I'm not exposed to this kind of lens
and thought about their everyday lives.
And also the meta,
like how can we change things so they're
better for the future?
So that has been really good for me.
And I got to meet a ton of
people that I've never met before.
So I always love that.
This isn't the area you're normally in.
Yeah, so I get to listen a lot,
which is so cool.
When you looked at the agenda,
as a practice owner, what made you say,
ooh, yeah, let's drill down on this.
That's exciting.
Yeah, so there were a couple things.
One was the opportunity to hear a little
bit more about
the APTA's decisions specifically with DEI
stuff, right?
So that was very interesting to me.
And then a couple of other pieces were,
you know,
talking about where we are with
reimbursement, honestly,
where we are with reimbursement,
how we're going about changing things,
what our plan is,
what are some of the options.
One of the things that I'd like to
hear a little more, quite honestly.
That's my next question.
Keep going, keep going.
We've talked a lot about the what's wrong.
and I'd like to hear a little bit
more about here's some options.
Here's some solutions.
So we know it's wrong.
We know reimbursement's declining.
We know we're having a harder and harder
time.
We're getting squeezed.
We're one of the very few industries that
is not tied to inflation.
I can raise my prices all I want.
I'm not going to get paid a dime
more just because inflation went up.
So how do we combat that?
So I'd like to hear a little bit
more of that kind of conversation,
and maybe we will today or tomorrow.
In what format?
Like people who've done stuff and then
they walk you backwards and reverse
engineer that for you?
Correct.
Exactly.
So we know there's a couple options out
there and we've heard a lot of those
options that they exist and maybe we
didn't know they existed.
But I'd like to hear some more about
how do you get there?
How do you get from point A to
point B?
Right.
that's why like a show like bar rescue
is kind of cool i mean i know
it's you know it's sort of set up
right but it's like we go in there
and there's the glaring problem john
taffrey yells and screams but they do a
pressure test everything explodes the
owner loses their mind but then they go
all right now here's how we're going to
fix it and i really like when they
do an episode that they go hey remember
that episode from three years ago well
they're still in business or they've
tripled their whatever you're like oh yeah
this stuff works over time
Which is good.
What's something that you thought should
have been on the menu?
Oh,
that's not what I thought you were going
to ask me.
I thought you were going to ask me
the question you asked him.
No, you're on a practice.
But how would you have answered that one?
I am really looking forward to tomorrow
because I have the good fortune of being
on a panel.
And I get caught in a vacuum of
listening of how to solve the problems
from academics.
And I really want to hear what a
business person has to say about how we
can solve this problem.
I watch that a lot.
I get caught in that a lot, right?
Because I do live streams with business
owners and we're like, you know,
academic this, this, this.
And then I know somebody who's in
academics and you're like, okay,
I see what you're saying.
But actually, that's not how,
not even just how it works.
It's like,
we've tried that or you can't do that
because of A, B, X, Y, Z.
So it's good to know that.
Why don't you just do this?
And you're like, oh, hey,
thank you for pointing out that thing
that's so obvious in my line of work
that I can't do because of these seventeen
reasons.
You're like, oh, I didn't know that.
Sorry.
So to answer your question,
not be a bad guest,
the question that you did ask me,
what did I want to see?
Or what did you look at and say,
oh,
I thought that would have been an edgy
top,
like something Graham Session worthy that
wasn't?
knowing that they can't put everything.
Right,
they can't put everything because it's a
pretty small conference.
But I don't know.
I would have liked to see something.
And we touched on this a little bit,
but like...
How to maintain your optimism.
Okay.
Or how to continue to think big in
a world that seems to be more restrictive.
Squeezing.
Yeah.
Going into the diamonds caused under
pressure.
Yeah.
So how do we keep diamonding?
Yeah.
I would say Rihanna, but there's no way.
We can do that.
We'll do that later.
And I was just talking with Patrick
Graham.
You guys are following Patrick Graham,
the guy...
this thing's named after.
And he and I both concluded,
I was like, these are great discussions.
I'm like, Patrick, but where's the real,
where's the real conversation?
He's like the bar.
And I'm like, right.
We know that the answer,
which is why this podcast,
how this podcast originated.
If you were to be on the planning
committee for next year,
what would you be like this?
Either I'm going to give this talk or
I need,
this needs to be here next year.
What would you do if you had sixteen
years?
What do they say?
Ninety percent of the biggest person,
three years.
And if you make it past three years,
it's like, dude.
Yeah, exactly.
So what I would probably say is one
of the topics and Sky just sort of
touched on it.
You know,
how do you maintain the optimism?
How do you how can we sort of
combat all the challenges that we're
facing as a profession right now?
without changing the quality of what we
do, right?
So I would sort of focus on that
piece.
I'd say, all right, well,
what's successful?
What works?
How does it work?
And how do you make sure that we
value our people,
that we value the care we give,
and put that above all else?
We stop competing with each other, right?
We stop competing with other PT practices,
and we focus on competing
to get paid what we deserve, right?
And what's the key to that piece,
I think?
You are in academics.
You take people to work for you who
have just graduated from academics.
What's something that you think is
important?
Right now,
the discussion going on right now is about
generations.
And we're like, what's important to you?
And how do I figure that out instead
of these kids today?
These kids today...
It's usually followed by a negative.
Some of these kids today are so
innovative.
It's usually negative.
But how do you or how have you
over sixteen years been able to say like,
all right,
here here is a generational divide and I
need to figure out how to incentivize or
work with this person when they value
something drastically than I did?
Yeah.
So I think I think that answer is
it's probably pretty simple,
but maybe not easy.
uh the great things are yeah right and
so um it's just doing what we as
physical therapists do the best right from
we talked earlier today about the
diagnostic tools that are now potentially
available in a bunch of different states
but I still think the thing we do
the best is listen.
And if we listen to the new graduates,
to the prospective hires,
and figure out what motivates them,
figure out what they want to do.
Do they wanna own a practice someday?
Do they wanna manage a practice someday?
What do they wanna see?
They wanna see a bunch of athletes that
like geriatric populations?
Talk to people, listen to them,
figure out what they want,
then figure out a way we can provide
that build that right build that so that
because listen if you came to work for
me jimmy and and you said mike i
really only want to see soccer players and
basketball players i said okay you know
what i will do everything i can to
get you that population you got to work
with me a little bit as often as
possible i need to fill up your schedule
but as much as we can i will
get you relationships with the people who
are going to send you that population and
i'll support you because this is what you
love right honestly if you do what you
love
It's great.
Right.
What's the old saying?
You never work a day in your life.
Right.
Yeah.
I believe that's very true.
I heard a great interview question that
you can find something like this out,
tease it out, which is, uh,
the guy taught me to ask, uh,
in the initial interview,
when you're hiring a clinician, um,
if you were to quit in two years,
why, why, why would that be?
And if they're,
if they say something like, well,
if you didn't pay me enough or if
it was like,
there's no growth or I wasn't seeing that
there, instead of saying like,
What do you need?
It's saying, why would you leave?
It turns it into a story.
That's why people don't leave his clinic.
I mean, really,
he listens to them and he helps them
see what's valuable to them and then he
tries to make it happen.
I feel like you pointed out that the
job of a business owner is to create
a good environment.
and listen but the job of clinician is
to create a great environment and listen
differently right but doing both of those
things for different audiences can lead to
success absolutely you see and interact
with students long before they graduate
and join the workforce um what can
academics teach business about these
things or how to predict what's coming
like i feel like you should just be
like writing messages in a bottle to mike
and be like okay in six years these
students are gonna be like this and you
should do this
I really think we need to be better
in academics about having it be
bi-directional because we get a lot of
these kids today,
we get it from the clinics and they're
like,
you guys aren't doing a good enough job
in academics to prepare them for what real
life clinic is like now.
So I think that we should be working
together more to sort of develop a
curriculum and a more, you know,
in context learning experience so they can
understand what the current challenges but
then how do they turn those into
opportunities i'm always thinking about
too like we need to give them more
for what they're paying for and what
they're doing like students you mean yeah
i mean like i just think about can
we give them a skill set where it's
like how do we get them to be
more entrepreneurial and how do we do
design thinking because
we can't just prepare them for the way
that how I practice physical therapy,
you know, it's like,
we have to prepare them to be like,
what's the next thing.
And if we want the profession to move
forward,
we should also spend some time developing
almost like what you'd see in a business
curriculum, not how to open a business,
but how do you have that mindset to
think bigger than what we are now?
Cause I'm always also thinking about the
profession and it's like,
we keep having the same discussion over
and over again.
Like, why don't people know what we do?
Like,
Why don't people see the value?
We know that we give great care and
it's more economical and we do prevention,
but it's like, no, still,
we're not moving the needle as far as
we can.
So I'm sort of like, well,
do we create armies of people who,
you know what I mean?
Like,
I am not the first person to say
this, but why do we teach goniometry?
goniometry over sixteen weeks.
I don't know.
It's the same device.
Just pick a different joint.
Maybe we just do,
here's one ball and socket,
here's one hinge joint.
Do it on the upper and lower extremity.
We'll teach you the spine.
I get it.
There's academic bloat.
What do you take out?
What do you put in?
But I think we have to rethink it.
Love it.
Yeah.
Same question,
but different point in life.
How do you know when someone walks in
who's just graduated,
who's going to be a great clinician?
And how can you tell when someone walks
in, they're going to be a great student?
So what are you looking for?
What are the things that you're like,
yeah.
great clinicians, probably, mostly for me,
when I sit down with somebody for an
interview,
the kind of things I want to hear
from them are not about all the different
things they've seen in other clinics or as
a student or anything like that.
It's
It's probably hard to quantify.
It's, it's a motivation.
It's a, it's a desire to see.
And it's a passion.
If they've got a passion about something,
if they,
if they can explain to me something they
love,
and it's one of the questions I always
ask is, tell me what you love.
What do you love about physical therapy?
Like, why do you love physical therapy?
And quite honestly,
I've had some interviews where they, well,
I'm not sure I do.
You're like, got it.
And you're just drawing a right line.
Well, so maybe, but,
but the first question I asked after that
is, why?
I love what I do.
I love what I do every day since
I've been doing it.
I've been doing it for twenty five years.
So like I don't know how you couldn't
love this.
Tell me about where you work now.
Tell me about your last experience.
What was not to love?
What would you not like about that?
Right.
Because then I'll get a sense of because
if they describe my office and they don't
love that and they don't love that,
they're not going to love me.
Right.
And they're not going to come work for
me.
But if they describe an office where
they're asked to see thirty patients a day
and they're not given the time and not
given the support and they're not given
Con Ed and they're not given any sort
of professional development or
encouragement to pursue their passion.
I was like, well, I can fix that.
I can take care of that.
So you're at you're teasing out as an
environmental or internal.
Yep.
And if it's internal, I can't fix that.
I can't fix that.
There's nothing.
But if you were in a crappy situation,
let's get you in a better situation.
Yeah, exactly.
Yeah.
Okay.
Great answer.
So how do you want to answer this?
Do you want to answer what makes,
what do you see that you know that
this person is going to be a good
student?
Or what do you see while they're
a student that you're like, Oh,
this person's going to have,
this person's going to do great things.
I think the answer is the same.
Okay, good.
And I think it is people who are
successful,
who have enough self-awareness to be open
to change.
I think PT school is very challenging and
the people who are sort of like
this is not going to be forever.
I may need help in this.
I'm excelling at this and I'm going to
go like show my skills to somebody else.
And I'm going to feel proud of myself
for that two weeks that I actually had
my stuff together out of a hundred and
twelve weeks.
I had two.
But I think it's the person who is
adaptable and they are willing to like
know who they are,
what their shortcomings are,
what their strengths are,
and be able to kind of like
be okay with all of that because that
kind of a person is going to be
like our patients come in like that too.
Right.
So that kind of a person is like
someone who's like,
the job's going to be different every day.
I'm going to be working with different
people every day.
I'm willing to learn about them.
I'm open to growing as an individual
myself and not being kind of like stuck
in the like,
every day is going to be horrible and
I'm not doing great.
And it's like,
can we just sort of rise above and
like the students that really see this as
a opportunity to live in the moment and
do all the things in the moment,
but this is just for now.
And they have the capacity to be something
different at the end.
Do you remember when I had a clinical
in an underground mall?
I remember that.
What was the name of that mall?
It was like an underground bomb shelter.
It doesn't even exist anymore.
It was in Crystal City.
It was across from Panagon.
It was in Crystal City.
It's right here.
So I was in the food court of
an underground mall.
It was a national chain.
I'm not going to throw them under the
bus.
And I literally remember messaging you and
being like, is this it?
And you were like, no.
And I was like, well,
this feels like this...
I like to think I'm pretty resilient,
like at least like a B plus.
But I was like, what are we doing?
And my CI was rubbing butts through jeans.
He was like, dude,
I remember just being like,
I don't know what I'm doing here.
Yeah.
Underground mall where I was looking at a
subway restaurant because I was in the
food court.
Yeah.
And that was fun.
But I think I said something to the
effect because I say it all the time.
Well,
I think I said something like you can
learn as much about what you don't want.
Right.
And that's a valuable experience.
It is.
Yeah, that's right.
Look at it more like sculpture.
Like, what are we chipping away?
We're not going to have that.
Got it.
You need windows.
All right.
Check.
Because literally it was like winter.
It was like now.
So I would go to work at like
in dark, zero dark thirty.
I would leave at zero dark thirty.
Never saw the sun.
And I was just like, this is great.
This is this.
I used to play rock music loud and
give away beer and concert tickets.
But now we're rubbing butts through jeans.
And this is my job.
I'm like, cool.
In the dungeon.
And I'm like, well,
at least there's this on the bright side.
There's a subway right there.
Got as many subway punch things.
And I got a free footlong.
um uh is there anything i didn't ask
you didn't ask me what session i want
to see oh yeah sorry i forgot what
would you put on the docket how to
have a nerd lunch
What's a nerd lunch?
Oh, I have them all the time.
What is a nerd lunch?
So you know what a nerd lunch is.
Do I?
Yeah, because you've been to one.
I have.
You're going to be invited to the next
one.
I eat lunch with myself.
Yeah, no.
So where you have a lunch and or
it doesn't have to be lunch.
You have a moment and it's on a
repetitive schedule and you have a group
of people that do things that are
completely opposite to you.
So it's like your accountability group.
It's like, how do you form that?
Like if our group chat was just like,
we're going to meet Fridays at one,
twelve to one.
Right.
We all do in our group chat is
like a bunch of PTs.
But I don't think do any of us
do the same thing now?
Yeah.
And why is that good?
because I've said this before, it's like,
we gotta get out of the silo.
So I think having people that are
comfortable enough to challenge you,
and I think it's even better when they're
outside of the profession,
because they just look at things so
differently.
Yeah.
So I'm just going to come back.
I'm doing a cohort.
I'm a teacher now.
I'm teaching people how to podcast.
So I've been asked before.
I was like, I'll do it,
but only if a couple of you are
going to do it at once because it
doesn't make any sense.
So I've got three or four people going
through this at the same time.
And week one or two, I was like,
this is your homework.
Who are you talking to?
Make up a fake person.
As dumb as it sounds,
exercise actually helps.
And they're going through it and they're
doing their thing.
And then week two is like,
now I want you to like,
now it's what's one episode for this?
What's one problem?
And the funny part is the person who
their podcast is launching is like really
hard to articulate what they're trying to
do.
The other two people are like, oh, no,
no, no, this is it.
And they're able to rattle it off so
damn easy.
And then like, how are you doing that?
I'm like, watch,
you're going to be able to do it
for him.
He's going to be able to do it.
You're going to be able to do it
for the other people.
You have the curse of knowledge.
Like you've exhausted all the probable
solutions because you know this space.
And then you get another person that comes
in and they're like,
I've been tried this thing that you've
never heard of.
And you're like, no, what is that?
Three M the company three M did this.
they couldn't figure out how to do some
engineering thing.
And they were like,
some entrepreneurial Scotsman came up with
this idea.
Essentially he created open source problem
solutions.
So they were like, all right,
we're gonna put this on a website and
we'll put a bounty on it.
So some like,
the famous story that I heard on a
podcast was some shepherd was like, well,
have you tried this?
And these engineers were like,
what the hell is that?
And like, oh, well, we've, this, this,
this, and it solved it.
you needed a shepherd to solve an
engineering problem why because engineers
are taught engineering things they don't
know how to get the flock out of
here um all right uh is there anything
i didn't ask about uh graham sessions or
you know uh yeah all right we'll wrap
up uh last thing we do on the
uh episodes we call it the parting shot
This is the parting shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
I will point out,
I've been doing the parting shot for a
decade.
And just twenty eight minutes ago in
Graham Sessions, someone on stage,
I won't say who,
but a pretty prominent person was like,
do we have any other parting shots?
And I was like, that's my turn.
That's when you know you've been saying
something over here.
All right.
Parting shot.
Just last chance for whatever.
Mic drop moment.
Soapbox statement.
Something.
What do you got?
I think the main take home for me
from this whole Graham session has been,
if you find people who love what they
do,
you'll be successful running a private
practice.
But you got to find people who love
what they do and support them.
You know, one of the other,
I feel like I've been saying a whole
bunch of sayings today, but I apologize.
um is hire people smarter than you yeah
right and let them do what they're good
at yeah that second part's not easy like
that's why steve jobs that's why that's so
there's a cliche right but have you been
in that situation have you been the person
hired and then told what and how to
do oh yeah sure and that's terribly
frustrating and then the boss is like why
isn't this working well yeah i think i
said the other day which was uh
In the context,
it was the CEO kept messing with
marketing.
And I think my response was something
like, well,
if you keep putting your fingers in the
soup, don't be pissed.
It tastes like fingers.
Stop touching the marketing and then it
won't taste like fingers.
But it's simple, but not easy.
Parting shot.
Clears before beers.
I think that was my first party.
That was her party shot like ten years
ago.
Yeah, I'm saying that to my kids.
I'm like, just please, clues before beers.
So I heard this yesterday.
So it wasn't at Graham Sessions,
but I heard it yesterday.
So we were sort of like in the
lead up to Graham Sessions and it was
find the extraordinary in the ordinary.
Oh, what does that mean?
What do you think that what is that?
What do you?
I think you can mean whatever you want
it to mean.
I think it's like about reinvesting in
wonderment because I think right now we
don't have a lot of wonder in our
lives.
Good.
So I've been trying to spend some time.
I wonder what we should do.
Did you find this at dinner last night?
With the dinner that you were at.
At dinner last night,
I pointed out to people, you know,
I was a typical twenty five year old
rock radio DJ.
We would make fun of things and people.
That was our job,
like to sort of be a dick.
And now I'm like,
like if I find out someone likes,
I don't know,
Pokemon or Disney or whatever.
I used to be like, this is lame.
Now I'm like just excited that they're
excited, like finding extraordinary.
I'm like,
I don't care about Disney or whatever,
but I'm like, that's cool.
Why do you like that?
i'm never gonna like that thing that's
okay but it's like i'm actually excited
you you're super into hula hooping tell me
more about the hula hoop uh uh you
know community and how i can be a
part of it um so this is fun
uh i appreciate you guys doing this now
uh we should dip out of graham sessions
early and go to dinner sounds like a
plan
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.
Bulls**t!
See, Keith?
We read the script.
Happy now?