You're listening to the PT Pinecast,
where smart people in healthcare come to
make noise.
Here's your host, Jimmy McKay.
All right.
Thanks, voice guy.
Eric Robertson, Jimmy McKay.
Eric Robertson,
no stranger to podcasting and thinking
about big ideas.
I like big ideas.
These are the kinds of things that you
do.
You think about big ideas and you tell
people about them.
Yeah.
Well, you can't just have big ideas.
You kind of have to share them a
little bit.
And we used to share them in blogs.
You started a blog a long time ago.
Really long time ago, yeah, I think, in,
I think, in, I think, in, I think,
in, I think, in, I think, in,
I think, in, I think, in, I think,
in, I think, in, I think, in,
I think, in,
in our profession and the idea is great
get in a room talk about them but
am i you and myself like i hope
you get some solutions while you're in
there it's like talking about problems is
fun we call that therapy it needs to
be some constructive thoughts let's do
something about this so what are you ex
so the also the rule when respect the
rules of graham sessions is you're
supposed to not attribute it to any to
anyone and by it i mean an idea
so you can say what was said but
not who said it this way people are
free to move about the idea spectrum
What have you been excited to see either
discussed or at least on the docket?
Because we're still at noon on the first
day.
Yeah, I mean, we're just getting going,
which is great.
And it's already been so energizing and so
inspiring, as it always is.
And I think the thing that really got
me going was the last session.
It was about collective bargaining and
mega groups.
And I have to be honest,
when I saw that on the agenda,
I was like, what's that?
I don't think I want that.
But yeah.
know what it was about was pts coming
together and uh using their collective
power to gain leverage right and so there
was this idea of uh listen payers don't
really care about value which is a little
uh like surprising it hurts but okay yeah
you compassionately argue value and but
they don't respond to that they'll be like
happy to hear it but they're going to
respond to leverage and the next step of
that was learning what can we
incorporate in our business of physical
therapy that dentists have done right
who's done it who's faced similar or the
same or similar problems and what have
they done about it and then does that
apply to us because not everything applies
across different verticals and that's what
the the nice part of this conversation was
was it was constructive it was people who
were already solving it that way people
have created these uh mega groups if you
will or you know collaborative networks
where
they've gained leverage and they've been
successful.
So you have MSOs,
Managed Service Organization, or IPAs,
Independent Practice Associations,
and again,
there's more experts in the room.
How do we come together without having to
be bought and sold into each other?
We can remain separate.
How do we get a bunch of tubes
on a lake and just hang on and
now we're a big group,
but at any point I can be like,
I'm good, I'm still my own tube.
Right.
Yeah.
And, you know,
that was another idea that came up in
this is that, you know,
the business of physical therapy isn't
really complicated.
Right.
It's like people come in,
you do a thing that we all know
how to do to them and then we
build them for it.
Right.
So there's nothing necessarily secret
about physical therapy as a business.
Right.
And so it was about sharing and
collaborating and stopping the kind of the
fear of, you know,
or this like maybe misguided but totally
understandable sense of like, well,
I need this autonomy.
Because at the end of the day,
you gain more autonomy by collectively
owning the practice of clinical physical
therapy.
And now you can use that long lever
arm,
and you can bargain for things like better
rates.
Yeah,
I like the lever arm pull in there.
Now we can leverage.
That's one topic that was on there.
What's something you wish was on here?
What's something that you're like, hey,
man, maybe next year,
but why aren't we talking about this?
Yeah.
So, you know,
Graham Sessions has its roots in private
practice, right?
That's where it started from.
And at first,
when I first was coming to Graham
Sessions,
I think my first one was like the
second or the third one.
I can't remember which,
but it was almost exclusively private
practice owners in the room.
And it's since diversified, right?
And so now I think they announced there
was seventeen of the eighteen sections or
something represented here,
which is fantastic.
But there's still like a very business
heavy focus in that, which is good, like,
but
Sometimes I think education happens in a
different universe, right?
And so the things that are happening in
the economics that drive decisions in
education are very different from the
economics and the realities of what
clinicians in practice are experiencing.
So a good example of that would be,
you know, we're educating for less time.
Right.
Which makes sense.
Right.
Education costs are so expensive.
Cut a year.
Yeah.
Let's cut a year.
You know, but on the other side, well,
where does where you didn't learn
something for a year.
Right.
Or you learned it,
but it was twice as fast.
So it's half as good.
And I'm making numbers, but you get.
Yeah.
And, you know, and OK,
we can't generalize that all the way
across.
But but in general,
I think business owners are concerned that
PTs are coming out and they need more
training.
And so where does that come from?
How do you do that?
And I think that's something we need to
talk about.
As a matter of fact, somebody said, like,
OK, well,
we're talking about primary care physical
therapy.
And somebody mentioned, well,
residencies could solve that.
And I'm thinking to myself, OK, well,
there's like, what,
six hundred residency slots and most of
them orthopedics.
How many primary care residency slots do
we have to fix that?
It might be four.
Maybe it's ten.
I don't know.
Somebody surprised.
Not a lot.
Right.
But it's if you compare that to the
twelve thousand graduates we have each
year.
something's not working about our
residency model.
And so I think these are things I
would like to talk about is how do
we reimagine clinical training that
happens after you graduate that's still
absolutely required
and do that in a way that we
can scale it.
Do it from a position of abundance where
you don't have to accept a low salary.
You don't have to have a really long,
very expensive,
time-consuming residency that takes a
year.
And that's something that I've learned
from my art world.
So when I was in art school,
you learn about residencies,
and residencies are defined by the
institution.
So a museum might have a residency where
you come in once a week and do
some lectures.
A residency might be you go to Montana
and live in the wilderness for six months
and make art.
So the institutions define the residency.
And the analog into practice would be the
practices define the residency.
So seeing more residencies embedded or
created by the practice.
There are some out there that do that.
Yeah,
so residency is defined by the people who
are delivering them, right?
So if you have a clinic,
there's going to be certain variables that
are really important to you.
Your values are going to be there, right?
Maybe you value positive psychology
education, right?
Where does that go?
How does that fit into an orthopedic
residency,
which the accreditation process requires
the curriculum to be this big and full
of all of these things of orthopedics?
Maybe you don't see anybody with feet,
let's just say.
You don't need the feet curriculum.
But you don't want the psychology
curriculum.
And our current framework doesn't allow
for that.
And so I think we need to really
shake some things up if we want to
start training people more meaningfully
after they graduate.
What are you excited for in terms of
the future of PT?
I know a lot of times people look
at,
I don't think Graham Sessions is focused
on the negative.
I think it's focused on let's find ideas,
not just problems.
And we focus on,
by our nature of humans, what's wrong.
But what are you excited about in the
future of PT where we are now?
I like this question.
You know,
I had Jim Gordon on my podcast on
PT Outcast a few months ago,
and he said a thing that's been just
percolating in my head.
And it's like, you know,
the future is not guaranteed.
And the people who are working today are
defining the future.
And it's that idea, right?
Like, what is doesn't have to be,
you know, and I think, you know,
we have a lot of energetic people,
just you look around this room,
it's exciting.
And one of the themes of this is
right on the agenda that
you know,
diamonds are formed under pressure.
And so as, as a profession,
if we're struggling,
if we're feeling some pain points,
like let's lean in.
Yeah, I like that.
Hi.
I guess session just let out.
I don't know what was being discussed a
second ago.
I asked this question a few weeks ago
because I wanted to get a good litmus
test.
I came to my first Graham Sessions ten
years ago.
Didn't know what to expect.
I asked my audience on LinkedIn.
Of course,
it's biased because it's my audience,
whatever.
And I just said,
do you even know what Graham Sessions is?
And it was like eighty percent.
No.
did not know what it was.
So I think the funny part is we're
like,
make sure you don't tell anybody what was
said here.
I'm like, no one knows we're here.
Look,
we're like waving from the top of APTA
Tower here, but no one, everyone's like,
I don't know who that is.
I got stuff to do.
But how do we,
my thought of doing these live streams
was,
let's get these ideas out of the room.
I don't want, they're awesome here.
Let's spread them.
Uh, what's something that, uh,
that you wish it will be on the
docket tomorrow.
You get the dry erase board,
Keaton Ray and Sharon Dunn who facilitate
this now come to you and they go,
you got one slot.
What are you going to talk about?
Oh, okay.
Yeah.
So, you know, Keaton and Sharon,
by the way, are doing a great job,
like running into this.
This is,
this is good to see them running.
It's a good energy.
Um, and, uh,
and they've had some fun things happening.
I think if I was going to have
the dry erase marker,
if I could do that,
I would like to talk about the thing
I brought up earlier,
combining the worlds of education business
decisions and business.
And also the subcontext of that is the
pending crisis in grad plus loans.
Oh, yeah.
Right?
What would you now?
Yeah, we have a problem already.
And it's going to get worse.
Yeah, it's going to get worse.
And so I think that's the urgent thing
that I wish would have been on the
agenda.
Well,
there is some education in this room,
but if that's true,
which I think it is,
this is more business heavy and that's
fine.
It's housed under the APTA private
practice section.
Is there a space for a different name,
but a Graham Sessions of Education where
you get one hundred and fifty people in
the room and they go, hey, man,
hash it out.
We're not unlocking the doors until you
get some solutions.
Yeah, you know, I think there is,
but I think that would also be misguided.
Oh, why?
because the separate universe, right?
The universes need to evolve together.
Got it.
Okay.
Yeah.
So, so what I, what I think though,
it may be Graham sessions that needs to
maybe have a flavor of education, um,
that leans in a little bit more,
but you know,
you gotta be careful because it's like
different universes have different
cultures.
Right.
And so there's a culture here that has
existed and has evolved.
And there, as you said,
there's plenty of educators here in the
room.
Yeah.
Um,
How do we take that?
I don't really know.
Maybe that's the topic that we put on
the agenda.
Maybe we ask the room.
Yeah, right.
I mean, like you said, when it started,
it was business, business, business,
and then somebody along the way probably
said, we're talking a lot about academics,
but none of them are here to defend
or explain.
Maybe we should invite some.
A long time ago in Graham Sessions,
we had a session that was,
are we admitting the right people to PT
school?
Right, right, right, right, right.
And it was fascinating, right?
They did StrengthsFinder,
and they did it with entry-level PT
students,
and then they did StrengthFinder with...
For all the people who are attending
Graham sessions who are leaders of the
profession and like thought people and and
what would they find out completely
different Wow,
not a shock though not a shock but
completely different right the in general
PTs were like harmonizers and relators and
And then the people in the room were
not they were the strategy people.
They were the confronters.
They were yeah competition people Have you
ever taken that I have what do you
do you remember one or two?
There's five, right?
Yeah, five.
Yeah.
Do you know yours?
I do Yeah, so it was ideation.
We got it strategy.
Okay
communication, competition,
and my favorite one is woo.
I'm a woo.
I'm a number one woo.
I know, that's why we hang out.
Woo, communication,
but my communication was third, ideation,
futurist, and one more.
And then I bring this up because I
took StrengthsFinders once,
and it's one of those like
It's a strengths test.
What's the one with the INTP or whatever?
That's a personality test.
This is a strengths test,
which I know we're splitting hairs.
And I remember I was working for this
big, big, huge PT company, and my boss,
who was not a PT,
he was a management guy, was like,
I want to talk to you about your
spreadsheets.
I was like...
I immediately broke out into sweat.
And I was like, cool.
All right.
And he's like,
I want you to spend a lot of
time getting better at spreadsheets.
And I was like, okay.
Now I have a counter idea.
And he's like, what?
And I was like,
are the people at this organization who
are great at spreadsheet already,
are they getting better at communication
and ideation?
And he's like, well, no,
that's ridiculous.
And I go...
then why don't you just give the
spreadsheet test to the spreadsheet people
and let me go woo and I do.
I'm going to go out and woo.
And that didn't go over well because he
just wanted me to get in line.
And that's why I was like,
my time here is limited.
I understand I'm in the wrong spot.
We have a tradition on the show.
Every episode,
it's called The Parting Shot.
This is The Parting Shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
All right,
first time I've ever done live streams
from anywhere other than my living room.
We've recorded but never just streamed
this.
So I'm dumbfounded people are watching.
What are you doing?
Don't you have a job?
It's the middle of the day.
It is the middle of the day.
Parting shot brought to you by our friends
at Empower EMR.
They're giving you what clinicians are at
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Kick the tires and light the fires at
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All right, so your parting shot,
your last chance for a mic drop moment
or a soapbox statement.
What do you got?
What do I got?
I'm going to go back to this residency
model.
I think it's time,
and I think I'm ready to disrupt this
residency model and kind of turn it on
its head.
Um,
in the spirit of Graham sessions being a
little spicy, spicy,
I want to wreck the accreditation model
for residency.
I think that's completely broken.
It doesn't serve the profession.
Uh,
and so that's what I'm trying to do
with brain Smith, uh, with,
with this new entity that I'm starting.
So talk about that.
We didn't get into that.
What is brain Smith?
Yeah.
Brain Smith is a new education company.
We launched it last October and we're
going to be offering a really, uh,
excellent limited library,
but very highly curated, uh,
real high quality instructor content for
continuing education.
And then we're going to be partnering with
clinics and building residency programs
for them.
They are not good at it.
They don't have the time or the expertise.
And you're like, I slide in.
You want the want,
but you don't have it.
This is what we can do.
Yeah,
I've spent the past several years of my
career building hybrid programs and
developing hybrid programs,
building lots of curriculum and content.
And so I've developed really nice systems
for this.
So let me do that.
And you do.
I'll save you time because you'll pay me,
but I'll get the thing done faster,
better than you would.
Right.
And you continue to do the thing that
you do.
Yeah.
And then it'll be nice because, you know,
the clinician or the clinic rather gets to
define what their values are.
I see what you mean.
Now, this looks like them.
This looks smells like them.
Right.
As it should.
Right.
So it's not like here's my residency
certificate.
curriculum you take it and go with this
it's going to be like i have no
idea what i want but i can tell
you the ingredients or what i want it
to feel like yeah the end we treat
butterflies at this clinic okay so i have
a butterfly course got it right like that
kind of a thing perfect and where do
people go to find out more brainsmith.org
brainsmith.org uh eric robertson
appreciate you uh having the guts to do
the live stream yeah we survived it's a
good time it's a good time we survived
back to grams
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And legally, none of this was advice.
It's for entertainment purposes only.
Bullshit!
See, Keith?
We read the script.
Happy now?