WEBVTT 00:00:00.269 --> 00:00:02.291 You're listening to the PT Pinecast, 00:00:02.371 --> 00:00:04.375 where smart people in healthcare come to 00:00:04.456 --> 00:00:05.317 make noise. 00:00:05.636 --> 00:00:07.059 Here's your host, Jimmy McKay. 00:00:10.102 --> 00:00:11.083 All right, thanks, voice guy. 00:00:11.122 --> 00:00:12.423 Big thanks to Sarah Health, 00:00:12.464 --> 00:00:14.464 a remote care platform helping clinics 00:00:14.505 --> 00:00:17.025 boost revenue without adding staff. 00:00:17.166 --> 00:00:19.106 Sarah automates daily patient check-ins 00:00:19.146 --> 00:00:20.187 via text. 00:00:20.407 --> 00:00:22.147 That means no app, no logins, 00:00:22.667 --> 00:00:23.528 just better outcomes. 00:00:23.949 --> 00:00:25.429 It's a simple way to meet RTM 00:00:25.449 --> 00:00:27.410 requirements, improve follow-through, 00:00:27.931 --> 00:00:29.852 and actually get you reimbursed for care 00:00:30.132 --> 00:00:31.391 between visits. 00:00:31.472 --> 00:00:33.093 Find them online at sarahhealth.com. 00:00:33.112 --> 00:00:36.414 That's S-A-R-A health.com. 00:00:36.914 --> 00:00:37.655 Now imagine... 00:00:38.712 --> 00:00:39.491 You're in a DeLorean. 00:00:39.692 --> 00:00:41.793 But instead of checking the time circuits, 00:00:42.414 --> 00:00:44.174 you're scanning tuition statements, 00:00:44.594 --> 00:00:45.335 burnout rates. 00:00:45.816 --> 00:00:46.875 The year on the dashboard, 00:00:46.915 --> 00:00:48.997 twenty twenty six and the dashboards 00:00:49.857 --> 00:00:50.618 flashing red. 00:00:51.279 --> 00:00:54.441 Something's wrong in the timeline of PT 00:00:54.500 --> 00:00:54.960 education. 00:00:55.180 --> 00:00:55.780 It's bloated. 00:00:55.941 --> 00:00:56.502 It's broken. 00:00:57.222 --> 00:00:58.823 And it's barreling towards a cliff, 00:00:59.124 --> 00:01:00.426 or maybe we went over one already. 00:01:00.945 --> 00:01:02.707 So three longtime disruptors, 00:01:02.807 --> 00:01:04.990 part educators, part entrepreneurs, 00:01:05.090 --> 00:01:06.912 part Doc Brown with spreadsheets, 00:01:07.272 --> 00:01:09.555 grab the keys and hit eighty eight miles 00:01:09.596 --> 00:01:09.936 an hour. 00:01:09.995 --> 00:01:12.179 Together, they founded programs, 00:01:12.239 --> 00:01:13.000 launched companies, 00:01:13.040 --> 00:01:14.841 taken on the APTA and lived to tell 00:01:14.882 --> 00:01:15.201 about it. 00:01:15.221 --> 00:01:17.765 And they're back not just to warn the 00:01:17.805 --> 00:01:18.325 profession. 00:01:19.667 --> 00:01:20.367 but to rebuild it. 00:01:20.727 --> 00:01:23.512 This is Back to the Future, part one, 00:01:24.153 --> 00:01:26.174 the radical proposal to save physical 00:01:26.215 --> 00:01:29.399 therapy through a five-year DPT redesign. 00:01:30.120 --> 00:01:31.402 Let's welcome in the show, Tim Flynn, 00:01:31.481 --> 00:01:33.024 Larry Pence, John Childs. 00:01:33.084 --> 00:01:33.424 Gentlemen, 00:01:34.224 --> 00:01:35.846 how was my Back to the Future intro? 00:01:36.227 --> 00:01:37.269 Was it DeLorean-worthy? 00:01:40.063 --> 00:01:41.504 I would say it was Rivian worthy. 00:01:41.984 --> 00:01:42.506 Rivian worthy. 00:01:42.525 --> 00:01:43.225 There you go. 00:01:43.667 --> 00:01:44.468 Now, I got to tell you, 00:01:44.707 --> 00:01:47.230 I started this podcast by accident ten 00:01:47.250 --> 00:01:48.971 years ago when I was still a student. 00:01:49.332 --> 00:01:50.274 And I remember. 00:01:51.912 --> 00:01:52.371 A couple, 00:01:52.432 --> 00:01:54.612 and I think it was John walked by 00:01:54.653 --> 00:01:55.834 and you were having a conversation with 00:01:55.853 --> 00:01:57.114 someone and I said, who's that? 00:01:57.674 --> 00:02:00.055 And I remember someone saying, oh no, 00:02:00.355 --> 00:02:01.695 you don't want to talk to that guy. 00:02:01.897 --> 00:02:03.417 He does crazy stuff. 00:02:03.856 --> 00:02:05.257 And I remember hearing about you guys 00:02:05.278 --> 00:02:06.539 because I was still in school and hearing 00:02:06.578 --> 00:02:07.778 about you guys over the years going, 00:02:08.560 --> 00:02:10.980 all the crazy stuff they're doing feels 00:02:11.020 --> 00:02:12.121 like it makes sense. 00:02:12.181 --> 00:02:13.262 Am I the crazy one? 00:02:13.662 --> 00:02:16.282 So let's start out with this. 00:02:17.223 --> 00:02:19.584 What year would you set the time machine 00:02:19.625 --> 00:02:20.125 back to? 00:02:21.123 --> 00:02:23.605 When did PT education go off the rails? 00:02:23.786 --> 00:02:24.667 If we were going to go back in 00:02:24.706 --> 00:02:27.308 time to sort of change it before it 00:02:27.389 --> 00:02:30.531 sort of forked, when was it okay? 00:02:30.631 --> 00:02:32.872 And then when did Biff Tannen show up 00:02:32.893 --> 00:02:34.493 and ruin everything? 00:02:34.533 --> 00:02:34.693 Well, 00:02:34.734 --> 00:02:36.175 I'll just start off with a lighthearted 00:02:36.215 --> 00:02:36.675 comment. 00:02:36.835 --> 00:02:38.817 I should defer to my elders, 00:02:39.477 --> 00:02:40.478 Larry and Tim. 00:02:40.518 --> 00:02:42.359 They have more of the history than I 00:02:42.399 --> 00:02:42.620 do. 00:02:47.703 --> 00:02:48.604 We live the history. 00:02:48.644 --> 00:02:49.024 In fact, 00:02:49.064 --> 00:02:50.727 we graduated pretty close together, 00:02:51.168 --> 00:02:53.251 Tim before me, so he should go first. 00:02:54.111 --> 00:02:55.473 All right, Tim, when did we mess up? 00:02:56.536 --> 00:02:56.735 Well, 00:02:56.895 --> 00:03:00.179 I started as a bachelor's and actually 00:03:00.579 --> 00:03:03.000 with a bachelor's was teaching people like 00:03:03.061 --> 00:03:05.861 Larry who was getting a master's at Army 00:03:05.901 --> 00:03:06.282 Baylor. 00:03:06.323 --> 00:03:08.403 So I guess I am the oldest. 00:03:08.443 --> 00:03:12.326 So I think from my perspective, probably, 00:03:12.787 --> 00:03:13.948 and I think I was part of the 00:03:13.987 --> 00:03:17.610 problem just when I look back at the 00:03:17.669 --> 00:03:17.931 time. 00:03:17.950 --> 00:03:20.472 But it was really when we went to 00:03:21.052 --> 00:03:21.913 the DPT, 00:03:21.932 --> 00:03:24.155 when you look at how that came about, 00:03:24.939 --> 00:03:27.640 the the conversation around that time was 00:03:27.700 --> 00:03:30.221 such that none of the universities are 00:03:30.241 --> 00:03:32.782 going to buy buy this you know it's 00:03:32.801 --> 00:03:35.301 going to be such a heavy lift to 00:03:35.361 --> 00:03:37.943 really go from a master's degree because 00:03:37.962 --> 00:03:39.983 the ninety it went to the masters to 00:03:40.002 --> 00:03:43.104 the doctorate and but what was fascinating 00:03:43.343 --> 00:03:45.563 uh literally you know within about five 00:03:45.604 --> 00:03:47.664 years everybody went there and i as you 00:03:47.705 --> 00:03:48.764 look back you go hmm 00:03:49.477 --> 00:03:52.877 You sit around the university and at the 00:03:52.918 --> 00:03:54.897 board of trustees or even down below. 00:03:55.337 --> 00:03:56.337 So let me get this right. 00:03:57.318 --> 00:04:00.239 You want to go from two years to 00:04:00.419 --> 00:04:03.658 three years and with the same number of 00:04:03.699 --> 00:04:04.219 faculty. 00:04:04.259 --> 00:04:06.439 So you basically we get another years of 00:04:06.539 --> 00:04:09.520 tuition with really little cost. 00:04:09.980 --> 00:04:10.941 Yeah, we should do that. 00:04:11.061 --> 00:04:11.820 We should do that. 00:04:11.901 --> 00:04:14.181 So basically all these universities went 00:04:14.200 --> 00:04:16.382 from zero to sixty and all of a 00:04:16.401 --> 00:04:18.281 sudden we have seven years of education. 00:04:18.999 --> 00:04:22.879 but i'll defer to my my junior colleague 00:04:22.959 --> 00:04:25.379 uh dr benz here because he he really 00:04:25.420 --> 00:04:27.701 has the most uh detailed perspective i 00:04:27.721 --> 00:04:31.961 think yeah so i think there's a couple 00:04:32.000 --> 00:04:34.942 surprises here and when i talk about this 00:04:34.961 --> 00:04:36.382 sometimes people look at me kind of 00:04:36.442 --> 00:04:39.603 strange but let's rewind the clock to how 00:04:39.622 --> 00:04:41.343 the profession looked at it by the 00:04:41.382 --> 00:04:43.803 profession i mean apta international 00:04:43.843 --> 00:04:45.004 organization because 00:04:45.744 --> 00:04:47.466 they led and carried the banner. 00:04:47.485 --> 00:04:49.749 And you also have to remember CAPT is 00:04:49.769 --> 00:04:51.891 to an extent intimately tied to them. 00:04:52.632 --> 00:04:53.353 So, you know, 00:04:53.372 --> 00:04:54.553 when I was in graduate school, 00:04:54.574 --> 00:04:56.456 in nineteen eighty four, Tim, 00:04:56.475 --> 00:04:57.958 you were getting out probably nineteen 00:04:57.978 --> 00:04:58.559 eighty five. 00:04:58.598 --> 00:05:00.000 You got up right at the beginning of 00:05:00.019 --> 00:05:00.721 eighty six. 00:05:00.761 --> 00:05:02.142 And so Tim is correct. 00:05:02.182 --> 00:05:03.223 He actually was one of our clinical 00:05:03.244 --> 00:05:04.906 instructors while he had a bachelor's. 00:05:04.985 --> 00:05:06.466 I chose a master's program. 00:05:07.327 --> 00:05:09.988 in part because it was the Army Baylor 00:05:10.028 --> 00:05:11.790 program and it was subsidized, 00:05:11.829 --> 00:05:13.050 but also in part because it was one 00:05:13.071 --> 00:05:14.752 of the few master's programs that was 00:05:14.771 --> 00:05:15.591 available then. 00:05:15.771 --> 00:05:16.492 Again, think about that. 00:05:16.591 --> 00:05:18.233 In nineteen eighty-four, 00:05:18.252 --> 00:05:19.754 there weren't many master's programs. 00:05:19.793 --> 00:05:22.454 So what drove the master's degree? 00:05:22.495 --> 00:05:24.076 What drove the master's degree was our 00:05:24.216 --> 00:05:24.915 profession. 00:05:25.355 --> 00:05:27.778 APTA said by nineteen ninety, 00:05:27.877 --> 00:05:29.038 and I think it was nineteen ninety, 00:05:29.077 --> 00:05:30.319 I'm going to be directionally correct 00:05:30.358 --> 00:05:30.519 here, 00:05:31.158 --> 00:05:33.399 All one hundred and eight programs at that 00:05:33.439 --> 00:05:34.641 time, whatever the number was, 00:05:35.161 --> 00:05:37.122 need to be at a master's level with 00:05:37.262 --> 00:05:39.163 whether they're both private or public. 00:05:39.223 --> 00:05:41.805 And obviously the privates exceed the 00:05:41.865 --> 00:05:43.625 public's because they have the flexibility 00:05:43.646 --> 00:05:45.226 and the autonomy to do so. 00:05:45.826 --> 00:05:47.067 Unfortunately, 00:05:47.507 --> 00:05:50.230 it wasn't until likely the last master's 00:05:50.269 --> 00:05:51.911 program probably hung around until the 00:05:51.951 --> 00:05:52.670 late nineties. 00:05:52.690 --> 00:05:53.572 We could look this up. 00:05:54.391 --> 00:05:57.634 but um there were a few laggards and 00:05:57.713 --> 00:05:59.574 lo and behold by the time the last 00:06:00.196 --> 00:06:02.656 master's program actually complied with 00:06:02.677 --> 00:06:04.699 the regulations by the way ot tried to 00:06:04.718 --> 00:06:06.660 do this very unsuccessfully just a few 00:06:06.699 --> 00:06:08.401 years ago it didn't work for them they 00:06:08.440 --> 00:06:09.901 tried to do it to the dpt or 00:06:09.922 --> 00:06:13.483 to the otd but in any event our 00:06:13.543 --> 00:06:15.946 profession said the body of knowledge is 00:06:16.005 --> 00:06:17.406 worthy of a master's degree 00:06:18.038 --> 00:06:19.658 Not everybody complied on time. 00:06:19.759 --> 00:06:20.819 And even though the mandate was, 00:06:20.839 --> 00:06:21.841 let's say, nineteen ninety, 00:06:21.860 --> 00:06:23.141 it took another ten years. 00:06:23.562 --> 00:06:24.684 Unfortunately, 00:06:25.264 --> 00:06:27.466 it only took a few years to convert 00:06:27.505 --> 00:06:29.067 from master's to DPT. 00:06:29.108 --> 00:06:29.947 And why was that? 00:06:30.007 --> 00:06:30.809 As Tim alluded to, 00:06:30.829 --> 00:06:32.810 it was driven by higher education. 00:06:33.170 --> 00:06:35.312 It was driven by the desire to get 00:06:35.432 --> 00:06:38.074 more bites of the apple in the tuition 00:06:38.115 --> 00:06:39.456 dollar from students. 00:06:40.036 --> 00:06:41.218 It just affect PT. 00:06:41.237 --> 00:06:42.439 It affected almost everything. 00:06:42.478 --> 00:06:44.201 They call that academic creep. 00:06:45.261 --> 00:06:46.740 Accounting went through it by way of 00:06:46.781 --> 00:06:47.321 example. 00:06:47.360 --> 00:06:48.882 Pharmacy went through it. 00:06:48.901 --> 00:06:50.182 Speech and hearing went through it. 00:06:50.302 --> 00:06:51.762 OTD obviously did as well. 00:06:51.822 --> 00:06:52.601 Many others did. 00:06:53.283 --> 00:06:56.543 And so that's a really fundamental thing 00:06:56.562 --> 00:06:57.502 we have to remember. 00:06:58.324 --> 00:07:00.423 At some point then the profession, 00:07:00.444 --> 00:07:01.944 Creighton I believe was the first program 00:07:01.983 --> 00:07:03.264 to go to a DPT level. 00:07:03.925 --> 00:07:06.084 And again, private schools exceeded, 00:07:06.144 --> 00:07:08.264 many states had to pass things within the 00:07:08.305 --> 00:07:10.286 regulatory bodies of their state's own 00:07:10.326 --> 00:07:11.245 higher ed to get 00:07:12.086 --> 00:07:13.987 physical therapy to a doctorate education. 00:07:14.007 --> 00:07:14.567 But the point, 00:07:14.607 --> 00:07:16.387 main point being is that it transitioned. 00:07:16.827 --> 00:07:18.189 It didn't take, let's say, 00:07:18.249 --> 00:07:20.649 fifteen years to go from bachelor's to 00:07:20.689 --> 00:07:21.230 master's. 00:07:21.269 --> 00:07:22.230 It was supposed to take ten. 00:07:22.250 --> 00:07:23.331 It only took about five. 00:07:23.750 --> 00:07:24.391 It was like, 00:07:24.531 --> 00:07:27.132 it just absolutely exploded because the 00:07:27.172 --> 00:07:28.293 tuition went crazy. 00:07:28.812 --> 00:07:30.973 So much so that when I have lots 00:07:31.014 --> 00:07:32.653 of friends and when I first started to 00:07:32.673 --> 00:07:35.235 employ PTs, we used to actually pay, 00:07:35.836 --> 00:07:37.175 we were still out of undergraduate 00:07:37.216 --> 00:07:38.976 programs when I was first in business, 00:07:39.036 --> 00:07:41.077 we used to actually pay scholarships. 00:07:41.737 --> 00:07:44.740 for PTs to get their bachelor's degree and 00:07:44.759 --> 00:07:45.779 then come work for us. 00:07:45.839 --> 00:07:46.980 Obviously by the time I got to a 00:07:47.021 --> 00:07:48.641 master's and certainly a DPT, 00:07:48.682 --> 00:07:50.783 who's gonna be able to afford three and 00:07:50.802 --> 00:07:53.685 four years of tuition dollars. 00:07:54.105 --> 00:07:55.745 One last point, I'll let John speak. 00:07:56.812 --> 00:07:59.514 We should not let higher education 00:07:59.875 --> 00:08:03.237 continue to dictate our profession because 00:08:03.778 --> 00:08:05.600 our profession has migrated. 00:08:05.639 --> 00:08:07.401 We'll talk about COVID and the impact it's 00:08:07.422 --> 00:08:09.744 had on quality and types of education and 00:08:09.783 --> 00:08:11.204 hybrid and all that kind of stuff. 00:08:12.024 --> 00:08:13.726 But we have the control. 00:08:13.786 --> 00:08:18.831 We have the ability to retrain this and 00:08:18.872 --> 00:08:21.454 go back to the future if we want 00:08:21.494 --> 00:08:21.754 to. 00:08:22.134 --> 00:08:23.675 It will take some regulatory changes. 00:08:23.795 --> 00:08:25.598 It'll take some gnashing of the teeth. 00:08:26.218 --> 00:08:27.759 But it really is going to take our 00:08:27.800 --> 00:08:29.762 profession to go back to commanding 00:08:29.802 --> 00:08:31.423 control of itself like it did from the 00:08:31.463 --> 00:08:32.465 bachelor's to the master's. 00:08:34.885 --> 00:08:35.106 Yeah, 00:08:35.167 --> 00:08:36.947 I think the primary comment I would have, 00:08:37.008 --> 00:08:38.948 and this is being as a critic to 00:08:38.989 --> 00:08:39.950 some extent of higher ed, 00:08:39.970 --> 00:08:41.890 I'm absolutely convinced if there was 00:08:42.292 --> 00:08:46.514 enough demand for a ten-year DPT program, 00:08:46.634 --> 00:08:49.856 higher ed would absolutely support it and 00:08:50.476 --> 00:08:51.798 move in that direction tomorrow. 00:08:52.139 --> 00:08:53.519 Now, that's a little bit facetious, 00:08:53.639 --> 00:08:56.621 but the reality is to some extent we 00:08:56.682 --> 00:08:58.523 are a victim of our own success. 00:08:58.582 --> 00:09:00.904 There is such demand for our services 00:09:01.485 --> 00:09:04.606 and a lack of therapists that are out 00:09:04.647 --> 00:09:07.328 there, that there's this motivation, 00:09:07.428 --> 00:09:08.090 obviously, 00:09:08.450 --> 00:09:11.131 to produce more and more therapists as 00:09:11.192 --> 00:09:11.532 needed. 00:09:11.631 --> 00:09:13.894 And the demand is so high and the 00:09:13.933 --> 00:09:17.535 willingness of the federal government to 00:09:17.596 --> 00:09:19.097 subsidize these loans, 00:09:19.437 --> 00:09:22.580 higher ed is just sitting on this heyday 00:09:22.840 --> 00:09:26.503 of extended academic creep, as Larry said. 00:09:26.562 --> 00:09:26.942 And again, 00:09:26.962 --> 00:09:28.163 that might be a little bit of an 00:09:28.244 --> 00:09:29.245 overly cynical view, 00:09:29.745 --> 00:09:32.086 But I think back to the time when 00:09:32.147 --> 00:09:33.707 I was in PT school in the Army 00:09:33.727 --> 00:09:35.609 Baylor program, similar to Larry, 00:09:35.629 --> 00:09:36.870 it was a master's program. 00:09:37.490 --> 00:09:40.692 And at that time, 00:09:40.873 --> 00:09:42.754 every program was a master's program, 00:09:43.153 --> 00:09:46.196 and most every program was two years in 00:09:46.277 --> 00:09:46.677 length. 00:09:47.899 --> 00:09:48.219 You know, 00:09:48.438 --> 00:09:51.120 we were being sponsored by the Army or 00:09:51.159 --> 00:09:52.419 the Air Force, in my case, 00:09:52.480 --> 00:09:55.139 who was incredibly interested in getting 00:09:55.200 --> 00:09:57.841 us out of school as soon as possible. 00:09:57.900 --> 00:09:58.120 Right. 00:09:58.441 --> 00:10:00.480 The motivation is entirely different. 00:10:00.520 --> 00:10:03.261 They're paying us salaries as lieutenants 00:10:03.302 --> 00:10:06.162 and captains to sit in a classroom and 00:10:06.221 --> 00:10:07.643 be relatively unproductive. 00:10:07.663 --> 00:10:07.822 Right. 00:10:07.842 --> 00:10:08.842 We're not seeing patients. 00:10:08.903 --> 00:10:10.903 We're on a pathway to get a degree. 00:10:10.942 --> 00:10:13.543 So the motivation was acceleration. 00:10:13.583 --> 00:10:14.783 The motivation was motivation. 00:10:15.024 --> 00:10:17.806 full time class, you know, eight to five. 00:10:17.885 --> 00:10:20.527 The motivation was no summers off. 00:10:20.908 --> 00:10:22.509 And so the Army Baylor program, 00:10:23.168 --> 00:10:24.048 even when I was there, 00:10:24.089 --> 00:10:25.149 was eighteen months. 00:10:25.269 --> 00:10:25.470 I mean, 00:10:25.490 --> 00:10:29.072 it was six months shorter than the 00:10:29.172 --> 00:10:31.014 average, quote unquote, two years master. 00:10:31.173 --> 00:10:31.553 And so 00:10:32.053 --> 00:10:32.293 you know, 00:10:32.453 --> 00:10:34.875 I think even with the master's program, 00:10:34.914 --> 00:10:37.437 we saw academic creep because there were 00:10:37.456 --> 00:10:40.398 at least some models where the incentives 00:10:41.138 --> 00:10:41.918 were different, 00:10:42.298 --> 00:10:45.519 where the time from inception to 00:10:46.080 --> 00:10:47.980 graduation was significantly shorter. 00:10:48.000 --> 00:10:49.721 All right. 00:10:49.741 --> 00:10:51.982 So now we fast forward and we've got 00:10:52.062 --> 00:10:53.724 regulations that are coming into play. 00:10:53.803 --> 00:10:56.024 So that rise rule, which everybody read, 00:10:56.655 --> 00:10:57.397 but they didn't read it. 00:10:57.437 --> 00:10:59.758 They read the abstract and panicked or 00:10:59.817 --> 00:11:01.419 they read it and said, well, 00:11:01.440 --> 00:11:02.701 you guys are the guys who actually read 00:11:02.721 --> 00:11:03.701 and understand this stuff. 00:11:04.221 --> 00:11:05.982 The rise rule could change everything. 00:11:06.624 --> 00:11:08.205 Are we about to see the federal government 00:11:08.264 --> 00:11:11.988 make DPT education impossible or is this a 00:11:12.048 --> 00:11:12.628 good thing? 00:11:12.648 --> 00:11:14.188 Help me read these tea leaves here. 00:11:16.971 --> 00:11:18.893 Let me comment on a couple of things 00:11:18.932 --> 00:11:20.854 before we go there a bit because there 00:11:20.874 --> 00:11:24.297 are some monumental inflection points in 00:11:24.397 --> 00:11:25.618 our profession. 00:11:26.707 --> 00:11:28.245 Um, two thousand one 00:11:29.955 --> 00:11:31.735 And the teaching point here is that we've 00:11:31.775 --> 00:11:34.618 never tried to control for supply demand 00:11:34.677 --> 00:11:36.099 or volume of PTs. 00:11:36.200 --> 00:11:37.539 And when the profession has tried to, 00:11:37.559 --> 00:11:38.721 they've been grossly wrong. 00:11:39.341 --> 00:11:41.243 So in two thousand one at that time, 00:11:41.283 --> 00:11:43.884 there were about ten thousand new graduate 00:11:44.004 --> 00:11:45.145 new PTs per year, 00:11:45.186 --> 00:11:46.667 ten thousand in two thousand one, 00:11:46.726 --> 00:11:50.570 five thousand American graduates of 00:11:50.629 --> 00:11:52.711 schools that would take their exam. 00:11:52.831 --> 00:11:53.532 And most of them, 00:11:53.912 --> 00:11:55.013 if not all of them, 00:11:55.033 --> 00:11:56.313 would practice clinically. 00:11:56.933 --> 00:11:57.434 At that time, 00:11:57.455 --> 00:11:58.817 there would be ten thousand foreign 00:11:58.859 --> 00:12:00.120 trained therapists that would come in the 00:12:00.221 --> 00:12:00.623 US. 00:12:00.883 --> 00:12:02.888 Half would pass the exam statistically. 00:12:03.248 --> 00:12:04.951 So another five thousand would become 00:12:05.011 --> 00:12:06.274 employed in the US. 00:12:07.048 --> 00:12:07.207 Now, 00:12:07.347 --> 00:12:08.607 up until about a year or two ago, 00:12:08.628 --> 00:12:09.928 we're now graduating about twelve 00:12:09.969 --> 00:12:10.448 thousand, 00:12:10.769 --> 00:12:12.048 although not all twelve thousand are 00:12:12.089 --> 00:12:13.048 practicing clinically, 00:12:13.109 --> 00:12:14.809 not all of them are passing the exam. 00:12:15.190 --> 00:12:17.230 But we are literally now in two thousand 00:12:17.269 --> 00:12:19.071 twenty six, 00:12:19.211 --> 00:12:21.390 roughly where we're at in two thousand one 00:12:21.431 --> 00:12:22.672 in terms of the same numbers. 00:12:23.292 --> 00:12:24.672 That is when we should have made a 00:12:24.711 --> 00:12:27.873 decision on PT education because we needed 00:12:27.913 --> 00:12:28.692 more PTs. 00:12:30.452 --> 00:12:31.793 Surprisingly, though, 00:12:32.333 --> 00:12:34.575 the academic community actually predicted 00:12:34.615 --> 00:12:36.115 that we were going to have this huge 00:12:36.196 --> 00:12:36.796 surplus. 00:12:37.517 --> 00:12:40.557 And that huge surplus caused this pushback 00:12:40.577 --> 00:12:42.899 for developing not only programs, 00:12:43.059 --> 00:12:44.880 expanding programs or innovation. 00:12:45.682 --> 00:12:46.583 Those three things, 00:12:46.604 --> 00:12:48.443 when you halt program development, 00:12:48.504 --> 00:12:49.585 you halt innovation, 00:12:49.625 --> 00:12:51.605 and you halt the expansion of programs, 00:12:52.086 --> 00:12:55.807 you literally are trying to restrict PTs 00:12:55.947 --> 00:12:57.229 in order to be able to get the 00:12:57.269 --> 00:12:58.149 number that we need. 00:12:58.190 --> 00:13:00.471 And now what we have is literally 00:13:01.130 --> 00:13:02.972 Seventy to eighty percent of people who 00:13:02.993 --> 00:13:05.034 apply for a PT education somewhere are 00:13:05.054 --> 00:13:05.875 going to get accepted. 00:13:06.375 --> 00:13:07.798 We have seats that are open. 00:13:07.898 --> 00:13:09.580 Who would have ever predicted in my 00:13:09.639 --> 00:13:11.181 monologue to this week's post, 00:13:11.201 --> 00:13:12.643 which will come out tomorrow or Wednesday, 00:13:13.062 --> 00:13:14.764 who would have ever predicted there'd be a 00:13:14.845 --> 00:13:16.546 time where anybody could become a PT? 00:13:17.787 --> 00:13:20.089 The qualifier is actually quite low. 00:13:20.708 --> 00:13:23.490 That has its own unintended consequences. 00:13:23.529 --> 00:13:25.130 So when we talk about rise here, 00:13:25.171 --> 00:13:26.412 we need to also, of course, 00:13:26.451 --> 00:13:29.033 correct the quality of students, 00:13:29.614 --> 00:13:31.173 coupled with those who are passionate and 00:13:31.193 --> 00:13:32.554 really want to become a PT, 00:13:32.914 --> 00:13:34.316 coupled with the ability to do it, 00:13:34.355 --> 00:13:36.017 the affordability and student loans, 00:13:36.076 --> 00:13:36.677 all those things. 00:13:37.038 --> 00:13:38.717 So we have to really kind of address 00:13:38.859 --> 00:13:40.759 all the challenges simultaneously, 00:13:41.120 --> 00:13:42.600 but we're going to keep pushing on one 00:13:42.701 --> 00:13:44.301 part of the sweater and another part is 00:13:44.321 --> 00:13:45.201 going to get a flaw in it. 00:13:46.245 --> 00:13:48.287 I sat in a room with two hundred 00:13:48.366 --> 00:13:49.868 ninety nine other applicants. 00:13:49.908 --> 00:13:51.288 They had narrowed it down for how many 00:13:51.349 --> 00:13:53.890 applications to three hundred in-person 00:13:54.030 --> 00:13:54.711 interviews, 00:13:55.110 --> 00:13:57.253 three one hundred person sessions for 00:13:57.312 --> 00:13:58.313 thirty eight seats. 00:13:58.354 --> 00:13:59.374 And I remember doing the math when I 00:13:59.434 --> 00:14:00.674 walked in going, man, 00:14:00.715 --> 00:14:02.056 I got it for every ten person, 00:14:02.096 --> 00:14:02.797 people that walk in. 00:14:02.836 --> 00:14:03.898 I got to be one of them. 00:14:03.957 --> 00:14:04.837 Sorry, I'd be nine of them. 00:14:04.898 --> 00:14:05.818 I got to be the one. 00:14:06.298 --> 00:14:07.460 And that gets a little intimidating. 00:14:07.500 --> 00:14:09.280 And now you hear some of the application 00:14:09.341 --> 00:14:12.283 rates falling through the floor. 00:14:13.024 --> 00:14:13.826 which is again, 00:14:13.846 --> 00:14:15.308 shocking in that short time span. 00:14:15.349 --> 00:14:17.292 Again, that was twenty thirteen for me, 00:14:17.312 --> 00:14:17.873 twenty twelve. 00:14:18.153 --> 00:14:18.455 All right. 00:14:18.475 --> 00:14:19.235 So where do we go next? 00:14:19.255 --> 00:14:20.317 Do we go do you want to fast 00:14:20.357 --> 00:14:22.121 forward to the to what's happening now or 00:14:22.162 --> 00:14:23.203 is there still some context? 00:14:25.798 --> 00:14:28.259 Well, I'll take briefly the rise question. 00:14:28.299 --> 00:14:29.980 It's obviously still out for comment. 00:14:30.000 --> 00:14:34.144 I think we're all hopeful that PT is 00:14:34.183 --> 00:14:36.745 going to get its due recognition as a 00:14:37.404 --> 00:14:38.785 profession, so to speak. 00:14:38.826 --> 00:14:40.226 It's to some extent, 00:14:40.567 --> 00:14:42.488 I don't know if it's humorous and or 00:14:42.869 --> 00:14:45.629 sad, probably some of both, 00:14:45.669 --> 00:14:48.432 that many other disciplines not to be 00:14:48.471 --> 00:14:50.493 named here are considered professions when 00:14:50.533 --> 00:14:52.313 we're not. 00:14:53.374 --> 00:14:54.914 But if we go down the path of 00:14:54.995 --> 00:14:56.934 sort of this worst case scenario where all 00:14:56.975 --> 00:14:59.696 of a sudden graduate loans are 00:14:59.755 --> 00:15:02.176 significantly curtailed, right, 00:15:02.216 --> 00:15:02.916 wrong or indifferent, 00:15:02.936 --> 00:15:05.557 it will absolutely force innovation in PT 00:15:05.616 --> 00:15:06.157 education. 00:15:06.576 --> 00:15:09.197 We will overnight see programs getting 00:15:09.258 --> 00:15:11.739 shorter, faster, more innovative. 00:15:11.818 --> 00:15:13.499 I'm not saying that's necessarily the path 00:15:13.958 --> 00:15:15.219 I wanna see us go down, 00:15:15.659 --> 00:15:19.100 but smaller under-resourced programs that 00:15:19.120 --> 00:15:21.461 have big buildings and lots of fixed costs 00:15:21.860 --> 00:15:23.182 they're all of a sudden, I mean, 00:15:23.221 --> 00:15:25.844 if you don't have more than fifty to 00:15:25.884 --> 00:15:27.544 sixty students in your program, 00:15:27.825 --> 00:15:28.926 you're going to go away. 00:15:29.005 --> 00:15:31.807 You simply don't have enough revenues at 00:15:31.847 --> 00:15:34.429 that level to support the cost of running 00:15:35.211 --> 00:15:35.870 a program. 00:15:36.350 --> 00:15:38.113 And so I think what we'll see in 00:15:38.133 --> 00:15:40.014 that worst case scenario is the strong 00:15:40.033 --> 00:15:40.894 getting stronger. 00:15:41.434 --> 00:15:42.115 And boy, 00:15:42.135 --> 00:15:44.616 there will be a third of DPT programs 00:15:44.636 --> 00:15:47.479 that will immediately start to struggle 00:15:47.639 --> 00:15:49.600 and or, you know, at some point, 00:15:50.086 --> 00:15:51.005 you know, disappear. 00:15:51.125 --> 00:15:51.907 Now, having said that, 00:15:51.947 --> 00:15:53.466 I've been predicting this, you know, 00:15:53.547 --> 00:15:55.807 third of PT programs going away for ten 00:15:55.847 --> 00:15:56.168 years, 00:15:56.768 --> 00:15:59.009 and it's just not happening at the pace 00:15:59.028 --> 00:15:59.708 at which I thought. 00:15:59.769 --> 00:16:01.149 So I'm guilty of, you know, 00:16:01.349 --> 00:16:03.289 maybe early forecasting, 00:16:03.990 --> 00:16:07.671 but certainly a significant change like 00:16:07.691 --> 00:16:09.032 we're talking about with some of the RISE 00:16:09.072 --> 00:16:12.312 regulations would absolutely force that, 00:16:12.773 --> 00:16:14.553 you know, 00:16:14.573 --> 00:16:16.573 those smaller under-resourced programs to 00:16:16.953 --> 00:16:18.375 rethink whether they want to be in the 00:16:18.414 --> 00:16:19.095 PT business. 00:16:20.187 --> 00:16:21.206 And you guys are going to go into 00:16:21.246 --> 00:16:24.447 detail with a series of articles, 00:16:24.488 --> 00:16:25.607 as I'll mention in the show notes. 00:16:25.648 --> 00:16:27.328 We'll give a link to that as well. 00:16:28.009 --> 00:16:29.369 So let's get to the solution. 00:16:29.509 --> 00:16:29.668 I mean, 00:16:29.688 --> 00:16:31.110 I think people are pretty familiar with at 00:16:31.129 --> 00:16:33.009 least some, if not all the problems. 00:16:33.649 --> 00:16:34.311 So great. 00:16:34.750 --> 00:16:37.431 As my research professor in PT school said 00:16:37.451 --> 00:16:39.272 with a great Irish accent, we know what? 00:16:40.032 --> 00:16:42.654 now what i'm sorry what so what now 00:16:42.715 --> 00:16:45.618 what break down that five-year dpt 00:16:45.638 --> 00:16:47.419 proposal is this the hoverboard 00:16:47.440 --> 00:16:49.100 everybody's been waiting for you know what 00:16:49.140 --> 00:16:50.663 how does it look what does it do 00:16:50.682 --> 00:16:52.465 to solve some of the problems we're we're 00:16:52.504 --> 00:16:57.149 currently in have at it well i'll i'll 00:16:57.168 --> 00:16:58.530 speak to that and um 00:16:59.508 --> 00:17:01.048 to say that really, 00:17:01.649 --> 00:17:04.549 all of us here probably had many 00:17:04.589 --> 00:17:07.289 undergraduate courses that really didn't 00:17:07.550 --> 00:17:11.771 prepare us to be excel and PT. 00:17:12.271 --> 00:17:13.852 And what I would mean by that are 00:17:14.292 --> 00:17:16.153 certain we're certain heavily on certain 00:17:16.173 --> 00:17:17.894 courses that just didn't translate. 00:17:18.453 --> 00:17:22.355 So but just as we've accelerated the DPT 00:17:22.375 --> 00:17:25.016 from three to two, at the bottom line, 00:17:25.096 --> 00:17:25.155 our 00:17:25.968 --> 00:17:28.191 our entry into the PT world should be 00:17:28.290 --> 00:17:28.711 quicker. 00:17:28.852 --> 00:17:29.092 I mean, 00:17:29.471 --> 00:17:32.015 three years as a three-year bachelor's 00:17:32.055 --> 00:17:32.516 degree, 00:17:33.136 --> 00:17:36.381 heavily focused on the skills of 00:17:36.421 --> 00:17:38.884 healthcare professionals so that the 00:17:38.923 --> 00:17:39.924 skills really are. 00:17:40.700 --> 00:17:43.001 Yes, a strong liberal arts background, 00:17:43.102 --> 00:17:44.102 actually, but liberal arts, 00:17:44.182 --> 00:17:47.865 it's applied to those skills that make you 00:17:48.045 --> 00:17:50.166 great at communicating with others. 00:17:50.467 --> 00:17:50.686 You know, 00:17:50.727 --> 00:17:53.148 those skills that actually translate 00:17:53.169 --> 00:17:55.529 across all the health care professions. 00:17:55.549 --> 00:17:58.332 So whether you go into a DPT or 00:17:58.352 --> 00:17:59.692 an OT program, 00:17:59.732 --> 00:18:02.035 a PA program or to medicine, 00:18:03.255 --> 00:18:05.976 You essentially have the background of the 00:18:06.115 --> 00:18:07.037 people skills. 00:18:07.517 --> 00:18:10.337 And that three-year bachelor's should 00:18:10.397 --> 00:18:15.059 include credit for 00:18:15.891 --> 00:18:17.912 people that are working in the health care 00:18:17.932 --> 00:18:20.653 industry already that are in people 00:18:20.933 --> 00:18:23.414 focused business or even people focused 00:18:23.474 --> 00:18:23.934 business. 00:18:24.035 --> 00:18:25.175 I often say, you know, 00:18:25.195 --> 00:18:28.377 I've always felt that bartenders and 00:18:28.617 --> 00:18:31.880 servers and waiters and waitresses are 00:18:31.920 --> 00:18:33.780 some of the best people to come into 00:18:33.820 --> 00:18:35.741 our profession because you basically have 00:18:35.761 --> 00:18:36.721 to think on your feet. 00:18:37.001 --> 00:18:38.343 You have to look people in the eye. 00:18:38.363 --> 00:18:40.003 You have to communicate with people. 00:18:40.364 --> 00:18:41.724 And when shit goes wrong, 00:18:42.204 --> 00:18:44.728 You have to think on your feet and 00:18:44.788 --> 00:18:47.329 pivot and make things right. 00:18:47.369 --> 00:18:50.693 That to me are a skill set that 00:18:50.733 --> 00:18:54.678 people should have credit for as you go 00:18:54.758 --> 00:18:57.540 into health care professions. 00:18:58.487 --> 00:18:59.948 To me, you know, 00:19:00.107 --> 00:19:03.169 there's heavily on the the sciences that 00:19:03.209 --> 00:19:06.029 are focused to what we need in PT 00:19:06.490 --> 00:19:08.810 and heavily on the humanities side of it, 00:19:09.310 --> 00:19:13.972 but also with practical skill sets that 00:19:13.992 --> 00:19:15.114 are people facing. 00:19:15.253 --> 00:19:16.673 And just one last comment. 00:19:18.174 --> 00:19:21.196 The thing that comes back always is, oh, 00:19:21.478 --> 00:19:24.640 you know, that's higher ed, you know, 00:19:25.019 --> 00:19:25.980 it's, you know, 00:19:26.040 --> 00:19:27.122 they're not going to pivot. 00:19:27.281 --> 00:19:28.363 And like we've said, 00:19:28.803 --> 00:19:30.345 people pivot immediately, 00:19:30.505 --> 00:19:31.726 like we did in COVID, 00:19:32.125 --> 00:19:34.728 when the situation requires it. 00:19:34.887 --> 00:19:36.869 But that's how I had probably started. 00:19:36.890 --> 00:19:39.131 I'll start on that kind of the entry 00:19:39.171 --> 00:19:39.791 point side. 00:19:42.978 --> 00:19:45.057 Just a couple observations. 00:19:45.238 --> 00:19:46.098 One on RISE, 00:19:46.798 --> 00:19:48.699 I'm going to predict that it's not going 00:19:48.759 --> 00:19:51.619 to end up being anything of significant, 00:19:51.700 --> 00:19:53.119 even if it stays intact, 00:19:53.160 --> 00:19:55.640 it'll get kicked down the road many years 00:19:56.180 --> 00:19:57.760 before it actually gets implemented. 00:19:57.800 --> 00:19:59.740 Again, this is just my opinion in part, 00:19:59.760 --> 00:20:01.681 not because of PTs, but because nurses, 00:20:01.740 --> 00:20:02.761 nurses usually win. 00:20:02.781 --> 00:20:04.902 They have strong advocates, advocacy. 00:20:05.382 --> 00:20:08.201 The reality is healthcare shortages are 00:20:08.261 --> 00:20:09.323 not in dispute. 00:20:10.143 --> 00:20:10.722 And, you know, 00:20:11.722 --> 00:20:14.703 putting forth an old reg on new student 00:20:14.743 --> 00:20:16.664 loan limitations doesn't make any sense 00:20:16.684 --> 00:20:17.244 for anybody. 00:20:17.565 --> 00:20:18.846 You think we have one of the lowest 00:20:18.885 --> 00:20:21.807 diversity percentages in PT would only get 00:20:21.886 --> 00:20:23.846 worse under those scenarios of rise. 00:20:23.926 --> 00:20:25.428 I think brighter minds will prevail. 00:20:25.887 --> 00:20:27.468 Having said that, regardless, 00:20:27.528 --> 00:20:29.709 we need more innovation in PT. 00:20:29.749 --> 00:20:31.509 The best example I'll go back to is 00:20:31.569 --> 00:20:31.970 nursing. 00:20:32.430 --> 00:20:33.871 You could get a nursing at an RN 00:20:33.911 --> 00:20:35.411 level, a BSN, MSN, 00:20:35.550 --> 00:20:37.751 a doctorate and nurse practice now. 00:20:38.527 --> 00:20:42.669 And we have to have some tools to 00:20:42.709 --> 00:20:43.009 do that. 00:20:43.048 --> 00:20:45.410 So I do like the three-year bachelor's 00:20:45.509 --> 00:20:46.890 into a two-year DPT. 00:20:47.250 --> 00:20:49.612 But I also like other flavors too. 00:20:49.771 --> 00:20:53.492 I like the idea of graduating in two, 00:20:53.673 --> 00:20:55.574 you know, baccalaureate for four even, 00:20:55.614 --> 00:20:57.954 two years in a DPT. 00:20:58.875 --> 00:21:00.395 Okay, that's an additional year, 00:21:00.455 --> 00:21:01.796 but then you would get a master's and 00:21:01.816 --> 00:21:02.477 you'd get paid. 00:21:03.297 --> 00:21:05.598 The reason why that's you get your license 00:21:05.778 --> 00:21:06.538 and you get masters, 00:21:06.558 --> 00:21:08.359 that's critical because we have horrible 00:21:08.400 --> 00:21:10.142 regulations that basically say if you 00:21:10.221 --> 00:21:13.042 treat a Medicare patient that is in, 00:21:13.784 --> 00:21:16.346 you know, life threatening Part A, 00:21:16.846 --> 00:21:18.586 you can do so independently without 00:21:18.646 --> 00:21:19.267 supervision. 00:21:19.287 --> 00:21:20.288 But in Part B, 00:21:20.567 --> 00:21:22.490 you can't get billed or reimbursed unless 00:21:22.529 --> 00:21:25.491 you are consuming the same oxygen as a 00:21:25.551 --> 00:21:27.212 licensed PT standing next to you. 00:21:27.913 --> 00:21:29.053 And so that regulation, 00:21:29.073 --> 00:21:30.013 we're not going to change. 00:21:30.054 --> 00:21:32.513 We failed at every Medicare regulation 00:21:32.554 --> 00:21:32.953 change. 00:21:32.993 --> 00:21:34.795 We take shallow victories and things that 00:21:34.835 --> 00:21:37.355 don't matter and things like direct access 00:21:37.375 --> 00:21:39.375 and things like the regulatory supervision 00:21:39.415 --> 00:21:40.115 requirements, 00:21:40.656 --> 00:21:43.017 eight minute rule and student supervision. 00:21:43.076 --> 00:21:45.298 We're not going to win, in my opinion. 00:21:45.857 --> 00:21:47.679 And so let's play the game and say, 00:21:47.719 --> 00:21:50.118 let's give them a license two years or 00:21:50.159 --> 00:21:51.799 halfway through PT school. 00:21:52.200 --> 00:21:54.180 So that way their billing will count. 00:21:54.279 --> 00:21:55.681 They will not be as productive. 00:21:55.701 --> 00:21:56.901 They do not have to start as a 00:21:56.941 --> 00:21:57.980 full time salary. 00:21:58.560 --> 00:22:00.582 Residents and interns don't get full time 00:22:00.622 --> 00:22:02.342 salaries either in the medical model. 00:22:02.843 --> 00:22:04.423 And that can become a pathway when you 00:22:04.462 --> 00:22:06.242 complete that time frame of a year, 00:22:06.262 --> 00:22:06.784 whatever it is, 00:22:06.824 --> 00:22:08.044 then you can get your DPT. 00:22:08.784 --> 00:22:11.204 So my point being is I think we 00:22:11.224 --> 00:22:14.125 have to develop a multitude of pathways, 00:22:14.526 --> 00:22:16.967 all of which uphold the rigor of academic 00:22:16.987 --> 00:22:18.646 and the competency and the knowledge base. 00:22:19.007 --> 00:22:19.948 But to Tim's point, 00:22:19.968 --> 00:22:22.368 what scares me the most is we will 00:22:22.409 --> 00:22:24.709 oftentimes default to too much technology, 00:22:24.729 --> 00:22:25.930 and then you're going to lose all tacit 00:22:25.970 --> 00:22:26.609 knowledge skills. 00:22:26.630 --> 00:22:27.990 You're going to lose collaboration and 00:22:28.049 --> 00:22:29.711 teamwork and empathy and compassion. 00:22:30.230 --> 00:22:32.032 And the things that really, you know, 00:22:32.053 --> 00:22:33.914 we're a victim of our success because we 00:22:33.974 --> 00:22:35.537 have the hands-on skills, 00:22:36.037 --> 00:22:37.558 we have the quantitative skills, 00:22:37.598 --> 00:22:40.461 but we also have the qualitative parts to 00:22:40.501 --> 00:22:41.603 our profession as well. 00:22:41.623 --> 00:22:43.265 And I'd hate to see that also be 00:22:43.325 --> 00:22:45.667 sacrificed for efficiency purposes. 00:22:47.833 --> 00:22:48.252 Yeah, 00:22:48.512 --> 00:22:49.673 I don't have a whole lot to add 00:22:49.733 --> 00:22:51.194 other than I do think nursing is a 00:22:51.234 --> 00:22:53.496 good example of, I mean, 00:22:53.935 --> 00:22:55.757 they have their own, you know, 00:22:55.896 --> 00:22:57.877 issues with so many accreditors and some 00:22:57.897 --> 00:22:58.699 of those kinds of things, 00:22:58.739 --> 00:23:00.619 but they've certainly been innovative in 00:23:00.660 --> 00:23:03.300 having lots of different pathways to all 00:23:03.361 --> 00:23:05.102 sorts of variations of 00:23:05.541 --> 00:23:07.864 master's degrees, bachelor's degrees, 00:23:07.923 --> 00:23:10.965 doctoral degrees to specifically equip you 00:23:10.986 --> 00:23:12.748 for the role that you're going to play 00:23:12.928 --> 00:23:15.309 in the nursing ecosystem. 00:23:15.490 --> 00:23:17.131 And at least in PT at this point, 00:23:17.171 --> 00:23:19.993 we sort of have a one-size-fits-all kind 00:23:20.034 --> 00:23:21.394 of an approach. 00:23:22.695 --> 00:23:24.217 And I would say I think the good 00:23:24.257 --> 00:23:26.699 news is we've got a lot of room 00:23:26.719 --> 00:23:27.318 to innovate. 00:23:27.439 --> 00:23:27.700 I mean, 00:23:27.720 --> 00:23:29.941 if you go back to the four-year bachelor, 00:23:31.241 --> 00:23:33.223 there was a time where there was 00:23:34.423 --> 00:23:35.344 I don't know if it was ever a 00:23:35.384 --> 00:23:36.505 third, a third, a third, 00:23:36.545 --> 00:23:38.707 but you'd be working in the same clinic 00:23:38.747 --> 00:23:40.989 with bachelor PTs, master's PTs, 00:23:41.229 --> 00:23:42.931 and doctoral PTs. 00:23:42.971 --> 00:23:44.352 Everybody would be in the same. 00:23:44.873 --> 00:23:46.314 And as you looked around at each other, 00:23:46.394 --> 00:23:47.694 I don't think any one of us would 00:23:47.755 --> 00:23:48.095 say, well, 00:23:48.115 --> 00:23:49.516 I'm a better PT than you are, 00:23:49.557 --> 00:23:51.117 or you're a better PT than I am. 00:23:51.498 --> 00:23:53.359 You've just had a different degree. 00:23:53.839 --> 00:23:54.059 Right. 00:23:54.421 --> 00:23:57.362 And now we're in a situation where there's 00:23:57.402 --> 00:24:00.023 probably few to there's probably still 00:24:00.064 --> 00:24:00.304 some, 00:24:00.324 --> 00:24:02.105 but there's probably very little bachelor 00:24:02.125 --> 00:24:03.606 PTs that are still practicing. 00:24:03.646 --> 00:24:06.248 And it's a mix of mostly doctoral PTs 00:24:06.268 --> 00:24:07.568 and some and some masters. 00:24:07.608 --> 00:24:09.550 My point in saying all that is we've 00:24:09.590 --> 00:24:12.412 got we've got like three years of room 00:24:12.471 --> 00:24:13.393 to kind of play with. 00:24:13.472 --> 00:24:13.692 Right. 00:24:13.833 --> 00:24:16.055 We went from four years all the way 00:24:16.095 --> 00:24:17.316 up to seven years. 00:24:18.316 --> 00:24:22.519 And so surely there are some innovative 00:24:22.579 --> 00:24:24.922 opportunities to bridge that gap. 00:24:25.782 --> 00:24:27.664 I think about it from the perspective of, 00:24:27.724 --> 00:24:27.904 you know, 00:24:27.924 --> 00:24:30.646 when we went from the master's degree to 00:24:30.686 --> 00:24:32.528 the DPT, you know, 00:24:32.669 --> 00:24:33.930 if you really look at it at its 00:24:33.970 --> 00:24:35.010 most foundational level, 00:24:35.030 --> 00:24:37.073 you have to ask yourself, OK, well, 00:24:37.393 --> 00:24:39.615 what else are PTs going to be learning 00:24:39.934 --> 00:24:41.957 in order to go from this master's degree 00:24:41.977 --> 00:24:42.538 to the DPT? 00:24:43.171 --> 00:24:44.251 At the end of the day, 00:24:44.571 --> 00:24:46.773 it was like diagnostic imaging, 00:24:48.275 --> 00:24:50.596 some primary care, medical screening. 00:24:51.037 --> 00:24:53.739 Think all things that would prepare us for 00:24:53.778 --> 00:24:55.299 direct access, right? 00:24:56.500 --> 00:24:59.242 Most programs were two years in length and 00:24:59.383 --> 00:25:00.323 higher ed, again, 00:25:00.383 --> 00:25:03.486 found a way to justify that that amount 00:25:03.526 --> 00:25:06.988 of content deserves an entire another year 00:25:07.107 --> 00:25:07.808 of education. 00:25:08.338 --> 00:25:09.859 When in reality, I mean, 00:25:09.900 --> 00:25:11.441 if we're really honest with ourselves, 00:25:11.721 --> 00:25:13.182 could we have done that in three months? 00:25:13.582 --> 00:25:14.823 Could we have done it in six months? 00:25:14.863 --> 00:25:15.482 For sure, 00:25:15.502 --> 00:25:16.804 we could have done it in six months. 00:25:17.884 --> 00:25:19.605 And so, you know, 00:25:19.765 --> 00:25:20.826 I don't think we have to get rid 00:25:20.865 --> 00:25:22.366 of the DPT and go back to the 00:25:22.406 --> 00:25:22.886 masters. 00:25:22.906 --> 00:25:24.748 I don't think anyone thinks that's really 00:25:24.788 --> 00:25:26.009 the path we're gonna take, 00:25:26.388 --> 00:25:28.390 but we can absolutely create these 00:25:29.711 --> 00:25:31.311 milestones along the way, 00:25:31.392 --> 00:25:33.633 like Larry alluded to, where, you know, 00:25:33.752 --> 00:25:34.773 we get a, 00:25:35.233 --> 00:25:36.174 a bachelor's degree, 00:25:36.214 --> 00:25:37.836 whether it's three years or four years, 00:25:37.915 --> 00:25:40.417 we go to a master's where we become 00:25:40.478 --> 00:25:42.240 licensed and we have the opportunity then 00:25:42.279 --> 00:25:44.922 to complete our, our DPT on the backside. 00:25:46.063 --> 00:25:47.143 And so there's just, 00:25:47.463 --> 00:25:48.805 there's a lot of opportunity, 00:25:49.184 --> 00:25:53.028 but we do have to have a regulatory 00:25:53.087 --> 00:25:55.990 body and a professional association that 00:25:56.009 --> 00:25:59.192 will embrace that, that innovation. 00:25:59.252 --> 00:26:00.473 If we continue to just 00:26:00.854 --> 00:26:01.173 You know, 00:26:01.273 --> 00:26:03.336 hit the hit the nail with the hammer 00:26:03.796 --> 00:26:05.196 and say it's a, you know, 00:26:05.317 --> 00:26:07.858 seven year DPT program. 00:26:08.720 --> 00:26:09.940 You know, we're never going to get there. 00:26:09.960 --> 00:26:10.840 Right. 00:26:10.861 --> 00:26:13.282 So who decides this or who needs to 00:26:13.303 --> 00:26:15.644 be the person that says this has to 00:26:15.683 --> 00:26:16.585 happen or else? 00:26:16.625 --> 00:26:16.724 Right. 00:26:16.744 --> 00:26:18.086 There needs to be consequences. 00:26:18.445 --> 00:26:20.086 It's a nice thing to have or it's 00:26:20.106 --> 00:26:20.887 a need to do. 00:26:21.248 --> 00:26:22.328 Who's in charge of that? 00:26:25.000 --> 00:26:27.701 Yeah, so just to allude to this, 00:26:27.741 --> 00:26:30.644 but employers of PTs are severely 00:26:30.703 --> 00:26:32.986 underrepresented in this argument. 00:26:33.605 --> 00:26:35.146 We grouse, we complain, 00:26:35.847 --> 00:26:38.130 but we seldom have any voice or influence. 00:26:38.190 --> 00:26:40.431 And so we have to have employers banding 00:26:40.471 --> 00:26:41.971 together and locking arms with our 00:26:42.031 --> 00:26:43.854 academics and our higher education with 00:26:43.894 --> 00:26:45.315 our regulators around this. 00:26:45.980 --> 00:26:46.141 You know, 00:26:46.161 --> 00:26:47.803 there's this other interesting phenomenon 00:26:47.843 --> 00:26:48.864 that sort of happened, 00:26:48.903 --> 00:26:50.987 I refer to as the post-COVID hangover. 00:26:51.626 --> 00:26:53.849 And that is the reality that during the 00:26:53.990 --> 00:26:55.050 COVID time period, 00:26:55.090 --> 00:26:56.873 things were incredibly relaxed 00:26:56.953 --> 00:26:57.954 regulation-wise, 00:26:58.095 --> 00:26:59.557 which allowed people to do remote 00:26:59.596 --> 00:26:59.916 learning. 00:27:01.653 --> 00:27:03.795 We were deemed heretics by our own 00:27:03.974 --> 00:27:06.036 profession for trying to do a two-year 00:27:06.076 --> 00:27:08.076 hybrid PT program. 00:27:08.616 --> 00:27:10.278 And we had decent number of years, 00:27:10.357 --> 00:27:12.199 even prior to COVID launching. 00:27:12.239 --> 00:27:12.939 COVID launched, 00:27:12.979 --> 00:27:14.460 our phones were ringing off the hook with 00:27:14.480 --> 00:27:15.500 people, how do we do this? 00:27:15.539 --> 00:27:17.820 Because we suddenly had academics, 00:27:17.861 --> 00:27:19.301 particularly in our own profession, said, 00:27:19.422 --> 00:27:20.162 never, ever, 00:27:20.221 --> 00:27:22.323 ever over my dead body will I teach 00:27:22.383 --> 00:27:22.863 online. 00:27:22.903 --> 00:27:24.483 Now, wanting calling and saying, 00:27:24.523 --> 00:27:26.263 how do I teach instructional design? 00:27:26.304 --> 00:27:27.265 How do I learn? 00:27:27.785 --> 00:27:28.865 and do things online. 00:27:29.425 --> 00:27:29.945 All good. 00:27:30.625 --> 00:27:31.385 Things have changed. 00:27:31.405 --> 00:27:32.646 There are a lot more programs. 00:27:32.686 --> 00:27:34.307 That's a step in the right direction, 00:27:34.327 --> 00:27:35.587 but it hasn't cured anything. 00:27:36.107 --> 00:27:37.769 And the reality is, as an employer, 00:27:37.828 --> 00:27:40.470 I can tell you that PTs are coming 00:27:40.650 --> 00:27:41.849 out with less reps. 00:27:41.890 --> 00:27:43.851 They're coming out with less clinical 00:27:43.891 --> 00:27:45.971 confidence and less clinical readiness. 00:27:45.991 --> 00:27:48.452 That's not an old fogey saying, you know, 00:27:48.853 --> 00:27:50.192 they're not as good as they were when 00:27:50.232 --> 00:27:50.753 we were there. 00:27:50.794 --> 00:27:52.794 That is well documented amongst the 00:27:52.834 --> 00:27:53.634 employer groups. 00:27:53.654 --> 00:27:54.474 So what do we have to do? 00:27:54.494 --> 00:27:56.655 We have to even put more resources 00:27:57.316 --> 00:27:59.596 into the training of new pts that have 00:27:59.876 --> 00:28:02.417 suddenly paid for six or seven years of 00:28:02.478 --> 00:28:04.157 school and aren't clinically ready now 00:28:04.178 --> 00:28:06.078 this just isn't a pt phenomenon i work 00:28:06.118 --> 00:28:07.679 in dentistry now it's the same thing there 00:28:07.700 --> 00:28:09.579 it's the same thing in primary care it's 00:28:09.619 --> 00:28:12.040 the same thing across because the regs 00:28:12.121 --> 00:28:14.182 relaxed enough were enough reps enough 00:28:14.221 --> 00:28:15.922 clinical experience so we do have to go 00:28:15.961 --> 00:28:17.863 back to a more lengthier 00:28:18.303 --> 00:28:18.544 you know, 00:28:18.584 --> 00:28:21.166 time period and on the clinical side and 00:28:21.227 --> 00:28:21.847 regain that. 00:28:21.928 --> 00:28:23.711 Is it a less quality student? 00:28:24.031 --> 00:28:24.392 I don't know. 00:28:24.412 --> 00:28:26.013 I'm not willing to go there necessarily, 00:28:26.074 --> 00:28:27.876 other than the failure rates seem to seem 00:28:27.896 --> 00:28:29.459 to suggest a correlation there. 00:28:30.000 --> 00:28:32.604 But I want to get a better clinical 00:28:33.484 --> 00:28:34.086 education, 00:28:34.165 --> 00:28:34.606 which we've 00:28:35.017 --> 00:28:37.200 collectively referred to as the big black 00:28:37.240 --> 00:28:37.441 hole. 00:28:37.461 --> 00:28:41.006 And we have some strong opinions about how 00:28:41.046 --> 00:28:41.767 to correct that. 00:28:42.208 --> 00:28:44.290 But I'll let Tim comment on the regulatory 00:28:44.391 --> 00:28:44.671 side, 00:28:44.711 --> 00:28:46.934 how we can figure out a way amongst 00:28:46.954 --> 00:28:48.797 the key stakeholders to get this thing 00:28:48.836 --> 00:28:49.157 turned. 00:28:51.969 --> 00:28:54.311 Well, thanks for that, Larry, I think. 00:28:57.214 --> 00:29:00.137 Part of it is... 00:29:00.337 --> 00:29:02.339 As the most current practicing academic, 00:29:02.380 --> 00:29:05.282 I thought you might have some ideas on 00:29:05.323 --> 00:29:06.163 how we can do that. 00:29:06.203 --> 00:29:06.723 Maybe not. 00:29:06.743 --> 00:29:08.266 Well, 00:29:08.405 --> 00:29:11.009 I was always offended when I was called, 00:29:11.128 --> 00:29:11.849 and I still am. 00:29:12.589 --> 00:29:13.691 called an academician. 00:29:13.871 --> 00:29:14.632 And I mean, 00:29:15.332 --> 00:29:17.094 I just have always felt that I'm a 00:29:17.114 --> 00:29:19.875 clinician and I never fit in the world 00:29:19.915 --> 00:29:23.258 of academia because it just, 00:29:23.618 --> 00:29:25.779 it's an area where, and again, 00:29:26.039 --> 00:29:28.882 I have wonderful colleagues in academia, 00:29:29.563 --> 00:29:33.526 but the difference between sitting around 00:29:33.546 --> 00:29:35.467 a table for an hour and a half 00:29:36.407 --> 00:29:38.829 and discussing things 00:29:39.773 --> 00:29:43.256 and debating things that just, 00:29:44.356 --> 00:29:46.778 you can't do that when you're actually 00:29:47.679 --> 00:29:48.960 trying to make payroll. 00:29:49.200 --> 00:29:51.421 I mean, that just, it just doesn't happen. 00:29:54.403 --> 00:29:57.144 Unfortunately, you know, you think about, 00:29:57.464 --> 00:29:57.704 you know, 00:29:57.744 --> 00:30:00.526 academia being liberal thinking and out 00:30:00.566 --> 00:30:01.707 there new ideas, 00:30:01.767 --> 00:30:03.367 and I would argue it is not. 00:30:03.548 --> 00:30:04.689 It is very much 00:30:05.410 --> 00:30:07.211 rooted in, you know, 00:30:07.830 --> 00:30:12.193 tradition and the threats of, you know, 00:30:12.253 --> 00:30:14.035 something doing something different. 00:30:14.134 --> 00:30:16.256 And that's just so I don't think 00:30:17.277 --> 00:30:18.237 unfortunately, 00:30:18.557 --> 00:30:20.398 universities are where we're going to look 00:30:20.459 --> 00:30:22.460 to see change happen. 00:30:23.180 --> 00:30:27.002 And and when it comes to regulatory 00:30:27.042 --> 00:30:30.223 bodies, you know, that's that's again, 00:30:30.243 --> 00:30:32.105 you know, 00:30:32.385 --> 00:30:32.786 rigid 00:30:33.507 --> 00:30:36.128 hard to push through hard to do anything 00:30:36.308 --> 00:30:39.289 innovative i really think the change 00:30:39.549 --> 00:30:43.833 happens unfortunately through the through 00:30:43.853 --> 00:30:45.814 a crisis is what we're seeing you know 00:30:45.834 --> 00:30:48.935 as we see you know this huge demand 00:30:49.435 --> 00:30:52.156 for our services but not able to create 00:30:52.176 --> 00:30:55.078 a product out there that that 00:30:56.536 --> 00:30:57.676 can meet that demand. 00:30:57.737 --> 00:31:01.741 So I'm more hopeful that, you know, 00:31:02.082 --> 00:31:06.847 our business leaders and our actually work 00:31:07.228 --> 00:31:09.590 areas will be able to 00:31:11.258 --> 00:31:13.778 change and partner with higher ed in a 00:31:13.838 --> 00:31:17.020 way that other businesses have to say this 00:31:17.060 --> 00:31:19.280 is what we need and we're willing to 00:31:19.340 --> 00:31:22.303 come and partner with you to create this 00:31:23.782 --> 00:31:25.284 if you know we know that you're gonna 00:31:25.344 --> 00:31:28.884 feed us a quality person to work in 00:31:29.005 --> 00:31:30.746 our in our in our field so that 00:31:32.727 --> 00:31:35.307 I guess my sense is it's going to 00:31:35.347 --> 00:31:35.468 be 00:31:36.457 --> 00:31:38.298 going to be hard but the second thing 00:31:38.377 --> 00:31:41.078 is with the this quote-unquote educational 00:31:41.118 --> 00:31:43.359 cliff I think the bachelor's thing isn't 00:31:43.400 --> 00:31:47.142 going to be that difficult because there's 00:31:47.281 --> 00:31:50.303 so fewer students that everybody's 00:31:50.343 --> 00:31:52.384 competing for and that bachelor's level 00:31:52.923 --> 00:31:56.566 that those that are innovative there 00:31:57.268 --> 00:31:58.788 I think we'll be able to scale up 00:31:58.828 --> 00:32:00.230 and have larger programs, 00:32:00.289 --> 00:32:03.311 especially if they really focus like some 00:32:03.332 --> 00:32:05.814 of these private, dare I say, 00:32:05.874 --> 00:32:08.595 for profit institutions that are actually 00:32:08.714 --> 00:32:11.497 responsive to a bottom line to say, hey, 00:32:11.916 --> 00:32:14.038 we can scale up and get more people 00:32:14.078 --> 00:32:15.900 through a bachelor's program in three 00:32:15.940 --> 00:32:18.121 years and feed into all these different 00:32:18.181 --> 00:32:22.243 health care programs that we all need kind 00:32:22.263 --> 00:32:23.644 of a similar skill set, I think. 00:32:24.484 --> 00:32:25.505 Whoever does that, 00:32:25.545 --> 00:32:26.905 and maybe some people are, 00:32:26.945 --> 00:32:29.046 but it's definitely not common. 00:32:29.405 --> 00:32:30.826 Whoever does that quickly, 00:32:31.227 --> 00:32:34.227 I think can rapidly fill seats and be 00:32:34.267 --> 00:32:36.928 able to help that side of the workforce 00:32:36.988 --> 00:32:38.868 and roll them into DPT. 00:32:38.929 --> 00:32:41.449 So that was a long-winded answer to say 00:32:43.769 --> 00:32:47.290 I'm not real hopeful that I can see 00:32:47.351 --> 00:32:48.730 disruption happening 00:32:49.619 --> 00:32:52.544 anytime soon but maybe i'm curious what 00:32:52.584 --> 00:32:55.048 larry's thoughts are actually because you 00:32:55.107 --> 00:32:58.232 always have those uh oh go ahead john 00:32:58.887 --> 00:32:59.627 Well, no, I was going to say, 00:32:59.647 --> 00:33:01.368 I'll just add one anecdote that sort of 00:33:01.409 --> 00:33:03.470 touches on sort of the resistance in 00:33:03.509 --> 00:33:06.611 higher ed and amongst accrediting bodies. 00:33:06.671 --> 00:33:08.251 And in our case, that's CAPTI. 00:33:09.173 --> 00:33:10.712 I mean, this is ten years ago, 00:33:10.752 --> 00:33:13.153 but I will never forget the moment that 00:33:14.295 --> 00:33:16.016 we sat across the site visitors. 00:33:16.036 --> 00:33:17.915 This was the very first hybrid two year 00:33:17.935 --> 00:33:19.836 DPT program at South College. 00:33:20.857 --> 00:33:22.218 This was probably I don't know if it 00:33:22.238 --> 00:33:23.519 was twenty thirteen, 00:33:23.979 --> 00:33:25.839 something around that time frame. 00:33:26.859 --> 00:33:29.461 This was the hybrid model where all the 00:33:29.681 --> 00:33:31.741 didactics were going to be done online, 00:33:31.781 --> 00:33:33.843 synchronously, asynchronously. 00:33:33.883 --> 00:33:35.323 Then when they came onto the campus, 00:33:35.363 --> 00:33:36.384 it was going to be eight, 00:33:36.423 --> 00:33:38.344 nine hours a day on your feet, 00:33:38.963 --> 00:33:40.105 getting all those reps in. 00:33:40.384 --> 00:33:42.506 This idea that psychomotor practice over 00:33:42.526 --> 00:33:43.246 and over and over, 00:33:43.746 --> 00:33:43.986 you know, 00:33:44.086 --> 00:33:45.807 over a seven to ten day period, 00:33:46.087 --> 00:33:46.268 you know, 00:33:46.288 --> 00:33:49.130 maybe those skills could be retained in a 00:33:49.190 --> 00:33:52.231 more effective way than this sort of 00:33:52.471 --> 00:33:53.292 lecture lab, 00:33:53.333 --> 00:33:55.634 lecture lab model that's very inefficient 00:33:55.674 --> 00:33:57.596 in a lot of traditional programs. 00:33:57.695 --> 00:33:59.597 And I will never forget when one of 00:33:59.637 --> 00:34:01.439 the site visitors looked across from me 00:34:01.479 --> 00:34:04.121 with this sort of blank stare and said, 00:34:04.181 --> 00:34:04.882 but John, 00:34:05.301 --> 00:34:07.343 by having them in labs all day long, 00:34:07.482 --> 00:34:09.284 you're going to exhaust these students. 00:34:10.329 --> 00:34:11.811 And I'm sitting there and I'll never 00:34:11.871 --> 00:34:12.871 forget my reaction. 00:34:12.952 --> 00:34:16.034 I had a really hard time not almost 00:34:16.173 --> 00:34:16.893 lashing out. 00:34:16.954 --> 00:34:18.094 I mean, I wanted to be like, 00:34:18.815 --> 00:34:21.016 that's exactly what we do as clinicians. 00:34:21.056 --> 00:34:23.378 We stand on our feet going from patient 00:34:23.398 --> 00:34:23.958 to patient. 00:34:23.998 --> 00:34:25.659 I mean, 00:34:26.119 --> 00:34:28.161 it's a marathon in the day of the 00:34:28.201 --> 00:34:29.862 life of a clinician. 00:34:30.021 --> 00:34:31.063 And so my point is, 00:34:31.103 --> 00:34:34.744 is that you have these sort of incumbents, 00:34:35.266 --> 00:34:36.606 dare I say gray hairs, 00:34:37.755 --> 00:34:39.996 that have not been in practice for many 00:34:40.056 --> 00:34:40.536 years, 00:34:40.836 --> 00:34:43.318 who've completely lost perspective with 00:34:43.398 --> 00:34:45.478 what a clinician does every day. 00:34:46.519 --> 00:34:48.159 And so, you know, 00:34:48.179 --> 00:34:50.181 we have to get the perspective of 00:34:50.260 --> 00:34:51.621 clinicians to Larry's point, 00:34:52.001 --> 00:34:55.583 employers have to band together, you know, 00:34:55.623 --> 00:34:56.664 without employers, 00:34:56.684 --> 00:34:57.824 we don't have clinical sites, 00:34:57.844 --> 00:34:59.106 employers have far more 00:34:59.746 --> 00:35:03.887 potential influence than I think we've 00:35:03.947 --> 00:35:05.409 realized as employers. 00:35:05.429 --> 00:35:09.351 So I think employers are a bright spot. 00:35:10.452 --> 00:35:11.311 Nursing, again, 00:35:11.331 --> 00:35:12.213 we've talked about nursing. 00:35:12.233 --> 00:35:13.713 They have so many different pathways. 00:35:14.054 --> 00:35:14.434 In part, 00:35:14.454 --> 00:35:16.494 that's because they have so many different 00:35:16.534 --> 00:35:17.215 accreditors. 00:35:18.215 --> 00:35:20.317 And so those different accreditors have 00:35:20.356 --> 00:35:23.119 sort of different flavors of kind of risk 00:35:23.199 --> 00:35:24.579 appetite for innovation. 00:35:25.139 --> 00:35:27.221 And it depends on the state you're in. 00:35:28.181 --> 00:35:29.902 I personally think we should have more 00:35:29.943 --> 00:35:30.724 than one accreditor. 00:35:30.784 --> 00:35:32.385 Right now we have one in CAPTI. 00:35:33.326 --> 00:35:36.487 The problem is individuals have looked at 00:35:36.547 --> 00:35:38.168 starting other accrediting bodies, 00:35:38.228 --> 00:35:40.952 but I'll forget how many states it is, 00:35:40.992 --> 00:35:42.813 but in let's call it twenty to thirty, 00:35:42.833 --> 00:35:44.273 it might even be forty states. 00:35:44.693 --> 00:35:49.657 CAPTI is specifically named in the 00:35:49.697 --> 00:35:51.519 practice act as you have to graduate from 00:35:51.619 --> 00:35:51.639 a 00:35:52.039 --> 00:35:53.300 CAPTI accredited program, 00:35:53.360 --> 00:35:55.181 not just an accredited program, right? 00:35:55.641 --> 00:35:58.364 And so in order to compete, 00:35:58.643 --> 00:36:00.063 so to speak, with CAPTI, 00:36:00.764 --> 00:36:02.306 you'd have to literally change practice 00:36:02.385 --> 00:36:03.266 acts in all these states, 00:36:03.306 --> 00:36:05.047 which would take fifty years to do and 00:36:05.067 --> 00:36:05.786 it may never happen. 00:36:05.847 --> 00:36:06.947 So, you know, 00:36:07.007 --> 00:36:08.028 at the at the end of the day, 00:36:08.068 --> 00:36:10.429 we need more competition and we need more 00:36:10.489 --> 00:36:13.251 willingness to accept really innovative 00:36:13.592 --> 00:36:16.713 practice models or educational models. 00:36:17.134 --> 00:36:18.393 What happens if it doesn't change? 00:36:18.574 --> 00:36:19.755 And we mean we need more 00:36:22.235 --> 00:36:22.755 Well, 00:36:22.795 --> 00:36:25.217 part of the unintended consequence of all 00:36:25.257 --> 00:36:26.579 this is, you know, 00:36:26.619 --> 00:36:30.282 physical therapy tuition in the higher ed 00:36:30.362 --> 00:36:31.402 level, I'll start there, 00:36:32.244 --> 00:36:34.646 has been unabated relative to their 00:36:34.766 --> 00:36:37.849 increases in cost and tuition factors. 00:36:39.090 --> 00:36:41.652 And so as that has exceeded inflation for 00:36:41.692 --> 00:36:42.411 so many years, 00:36:42.472 --> 00:36:45.355 it's finally starting to have, you know, 00:36:45.394 --> 00:36:47.295 some counterbalance in it because of some 00:36:47.335 --> 00:36:48.416 other disruption that's going on. 00:36:48.556 --> 00:36:49.378 I'm not talking about PT, 00:36:49.398 --> 00:36:50.699 I'm talking about higher ed in general. 00:36:51.322 --> 00:36:53.123 But the reality is who would go into 00:36:53.143 --> 00:36:55.324 the profession for the ROI that you get 00:36:55.664 --> 00:36:56.885 at this particular stage? 00:36:56.905 --> 00:36:58.905 That is our selfish motivation for wanting 00:36:58.925 --> 00:36:59.467 to correct this. 00:36:59.487 --> 00:37:00.827 We want our best and brightest to go 00:37:00.907 --> 00:37:01.226 into it. 00:37:01.588 --> 00:37:03.969 There is absolutely, in fact, 00:37:04.009 --> 00:37:05.548 the way you can tell the ROI is 00:37:05.588 --> 00:37:09.271 so bad is only about on an FTE 00:37:09.311 --> 00:37:09.931 basis, 00:37:10.592 --> 00:37:14.333 only north of of all licensed PTs practice 00:37:14.512 --> 00:37:17.474 PT, okay, on a full-time basis. 00:37:18.353 --> 00:37:20.014 What other profession can you name in 00:37:20.054 --> 00:37:22.376 health care that has that obstacle? 00:37:22.797 --> 00:37:24.697 What other profession, period, 00:37:24.737 --> 00:37:26.500 health care, unrelated to health care, 00:37:26.760 --> 00:37:28.721 can honestly say we've had less 00:37:28.780 --> 00:37:31.222 productivity today than we had ten and 00:37:31.262 --> 00:37:32.744 fifteen and twenty years ago? 00:37:33.625 --> 00:37:35.686 I don't know of any other occupation in 00:37:35.746 --> 00:37:37.447 America that can say that. 00:37:37.746 --> 00:37:38.947 But PT, we have. 00:37:39.469 --> 00:37:41.570 So the issue is we are overregulated. 00:37:42.282 --> 00:37:44.463 And unless you get a combination of 00:37:44.543 --> 00:37:47.547 decreased regulations and or enhancement 00:37:47.947 --> 00:37:49.507 of reimbursement, 00:37:49.949 --> 00:37:51.150 certainly don't see that coming. 00:37:51.590 --> 00:37:53.751 You're gonna have a degree that has priced 00:37:53.811 --> 00:37:57.554 itself out of competition for the souls 00:37:57.574 --> 00:37:58.795 and the minds of young people. 00:37:59.516 --> 00:38:01.480 I think the other issue is you have 00:38:01.519 --> 00:38:02.420 to get, you know, 00:38:02.460 --> 00:38:04.742 the problem is the states are relatively 00:38:04.784 --> 00:38:05.543 the easy ones. 00:38:05.625 --> 00:38:07.266 They basically say to get a license, 00:38:07.867 --> 00:38:09.489 you have to graduate from accredited 00:38:09.528 --> 00:38:10.010 program. 00:38:10.110 --> 00:38:11.190 I think we can get the ones that 00:38:11.210 --> 00:38:13.293 say CAPTI reverse with probably opening up 00:38:13.313 --> 00:38:14.255 that practice act. 00:38:14.295 --> 00:38:15.597 But, you know, it's an obstacle, 00:38:15.657 --> 00:38:17.157 but they're the easiest. 00:38:17.219 --> 00:38:18.780 The more difficult one is CAPTI. 00:38:19.320 --> 00:38:22.324 And CAPTI is intertwined, co-located, 00:38:22.764 --> 00:38:25.869 and housed by APTA and needs to respond 00:38:25.889 --> 00:38:26.911 to its constituents, 00:38:26.951 --> 00:38:29.092 which are PTs and employers and 00:38:29.152 --> 00:38:29.954 academicians. 00:38:30.675 --> 00:38:35.001 And we failed the first two times to 00:38:35.041 --> 00:38:36.442 try to get a hybrid PT program. 00:38:37.043 --> 00:38:38.543 We failed at it because it was 00:38:38.663 --> 00:38:40.224 unacceptable in the view of the 00:38:40.244 --> 00:38:40.844 accreditors. 00:38:40.864 --> 00:38:41.963 I don't know if that's public knowledge. 00:38:41.983 --> 00:38:42.784 I don't even know if I'm allowed to 00:38:42.804 --> 00:38:43.405 say that, John. 00:38:43.445 --> 00:38:46.646 But it's absolutely because they could not 00:38:46.726 --> 00:38:48.385 handle that type of innovation. 00:38:49.045 --> 00:38:51.987 Now you've got highbrow universities doing 00:38:52.047 --> 00:38:53.307 two-year hybrid programs. 00:38:54.367 --> 00:38:56.007 And we have to go down that same 00:38:56.068 --> 00:38:57.088 route, unfortunately. 00:38:57.128 --> 00:38:58.228 But what we can't do, 00:38:58.809 --> 00:39:00.349 we thought within a few years of the 00:39:00.389 --> 00:39:02.170 first hybrid program that there would be 00:39:02.269 --> 00:39:02.849 imitators. 00:39:03.150 --> 00:39:04.731 It didn't take till post-COVID. 00:39:05.210 --> 00:39:07.213 until, you know, two thousand twenty two, 00:39:07.253 --> 00:39:08.373 two thousand twenty three. 00:39:08.393 --> 00:39:09.514 These other programs came out. 00:39:09.554 --> 00:39:10.556 Meanwhile, we've got, I don't know, 00:39:10.596 --> 00:39:11.956 fifteen or seventeen of these. 00:39:12.338 --> 00:39:13.878 And now it's becoming more and more 00:39:13.958 --> 00:39:14.478 normalized. 00:39:14.800 --> 00:39:16.541 That's a good thing, but it's not enough. 00:39:16.822 --> 00:39:17.983 We need multiple pathways, 00:39:18.023 --> 00:39:20.105 but we've got to get the creditors in 00:39:20.144 --> 00:39:22.186 a room with employers and academicians. 00:39:23.126 --> 00:39:24.128 And like we said, 00:39:24.148 --> 00:39:25.849 the States are the easiest ones I think 00:39:25.869 --> 00:39:26.550 to overcome. 00:39:27.090 --> 00:39:28.552 And then you've got to get, 00:39:29.032 --> 00:39:30.833 you've got to get some pioneers out there 00:39:30.913 --> 00:39:32.094 and it's probably going to come from the 00:39:32.153 --> 00:39:34.456 for profits because they tend to be the 00:39:34.496 --> 00:39:35.836 most innovative and flexible. 00:39:36.898 --> 00:39:39.940 You cannot name great innovation with the 00:39:39.981 --> 00:39:41.561 exception of maybe Arizona state, 00:39:41.601 --> 00:39:42.543 not on the PT side, 00:39:42.563 --> 00:39:43.463 just talking generally, 00:39:43.784 --> 00:39:45.425 there are not a lot of high innovators 00:39:45.485 --> 00:39:46.865 on the public side that 00:39:46.945 --> 00:39:48.246 private side or even fewer. 00:39:48.286 --> 00:39:49.887 And so it's the for-profits that got to 00:39:49.907 --> 00:39:50.047 say, 00:39:50.086 --> 00:39:51.807 we'll do a bachelor completer program in 00:39:51.827 --> 00:39:53.068 three years and get you ready for a 00:39:53.128 --> 00:39:55.068 PT program that you can do a three 00:39:55.088 --> 00:39:55.869 plus two model. 00:39:56.349 --> 00:39:57.668 I think there's a pathway there and 00:39:57.688 --> 00:39:58.750 there's an opportunity, 00:39:59.630 --> 00:40:01.090 but it's going to take probably a younger 00:40:01.130 --> 00:40:03.570 set than Tim, Tim, John, I, 00:40:03.590 --> 00:40:05.072 and Rob Wainer to get it done this 00:40:05.112 --> 00:40:05.452 time. 00:40:06.621 --> 00:40:07.661 Maybe not. 00:40:07.681 --> 00:40:09.422 Follow along in the series as these guys 00:40:09.443 --> 00:40:10.403 keep writing about it. 00:40:10.603 --> 00:40:11.884 I'll share the link in the show notes. 00:40:11.923 --> 00:40:13.264 Do you want to say thanks to Empower 00:40:13.364 --> 00:40:14.664 EMR for supporting the show? 00:40:14.684 --> 00:40:16.626 If your clinic is stuck on an EMR 00:40:16.646 --> 00:40:18.867 that slows you down, you have to innovate. 00:40:19.407 --> 00:40:21.148 Empower gives you speed, clean workflows, 00:40:21.188 --> 00:40:22.907 and features PTs actually ask for. 00:40:22.967 --> 00:40:24.509 Better notes, faster documentation, 00:40:25.248 --> 00:40:26.349 smooth operations, 00:40:26.449 --> 00:40:27.750 all wrapped in customer support. 00:40:27.769 --> 00:40:28.590 It doesn't ghost you. 00:40:29.110 --> 00:40:30.411 EmpowerEMR.com. 00:40:30.811 --> 00:40:33.132 EmpowerEMR.com. 00:40:33.192 --> 00:40:34.972 If we don't change the timeline... 00:40:35.753 --> 00:40:36.753 If nothing changes, 00:40:36.813 --> 00:40:39.114 what does twenty thirty look like if there 00:40:39.735 --> 00:40:41.315 if Marty can't lose? 00:40:41.735 --> 00:40:41.936 Right. 00:40:41.956 --> 00:40:43.416 There's no tension in the story. 00:40:43.476 --> 00:40:44.617 People won't pay attention. 00:40:44.717 --> 00:40:44.956 I mean, 00:40:45.077 --> 00:40:47.277 I'm guessing if there if there isn't some 00:40:47.318 --> 00:40:48.398 consequence on the line, 00:40:48.438 --> 00:40:50.239 which we can see very clearly, 00:40:50.278 --> 00:40:51.960 even someone like me who's an amateur at 00:40:52.000 --> 00:40:53.159 this can see there's consequence. 00:40:53.740 --> 00:40:54.860 If we don't change the timeline, 00:40:54.900 --> 00:40:56.641 what does twenty thirty look like for the 00:40:56.681 --> 00:40:57.362 profession? 00:40:57.481 --> 00:41:02.603 And then we'll do parting shots. 00:41:02.623 --> 00:41:03.264 Looking at you, Tim. 00:41:04.465 --> 00:41:08.248 Okay, well, I guess if nothing changes, 00:41:09.748 --> 00:41:13.291 we'll continue to see fewer seats filled 00:41:13.451 --> 00:41:14.931 in DPT education. 00:41:15.952 --> 00:41:19.213 The type of applicant that we'll get 00:41:19.914 --> 00:41:22.275 probably in no shade here, 00:41:22.355 --> 00:41:23.815 it'll be people that love it. 00:41:24.425 --> 00:41:25.447 the profession, 00:41:25.847 --> 00:41:28.588 but probably have a trust fund or 00:41:28.648 --> 00:41:30.349 something else that allows them to go 00:41:30.409 --> 00:41:33.052 through higher ed without debt, 00:41:34.293 --> 00:41:37.094 but also probably would rather work 00:41:37.215 --> 00:41:40.677 part-time on the outside of it. 00:41:41.297 --> 00:41:43.619 We'll continue to see people doing it as 00:41:43.820 --> 00:41:47.041 more of a hobby, if you will. 00:41:47.922 --> 00:41:48.242 Again, 00:41:48.722 --> 00:41:50.643 more and more people working less 00:41:50.684 --> 00:41:51.344 full-time 00:41:52.108 --> 00:41:54.929 doing other things and having side gigs in 00:41:54.949 --> 00:41:55.710 the profession. 00:41:56.449 --> 00:41:58.231 And what fills the gap? 00:41:58.690 --> 00:42:02.692 Then it's just every other flavor of body 00:42:02.751 --> 00:42:06.913 worker will fill the gap out there. 00:42:07.592 --> 00:42:08.974 And the health of our society, 00:42:09.193 --> 00:42:11.554 I firmly believe will go down. 00:42:11.775 --> 00:42:14.514 As a physical therapist that sees over and 00:42:14.594 --> 00:42:16.936 over the failure of our system 00:42:17.873 --> 00:42:19.356 I'm not it's going to get a lot 00:42:19.456 --> 00:42:21.577 worse in terms of health care outcomes in 00:42:21.637 --> 00:42:24.059 our society. 00:42:24.159 --> 00:42:25.161 All right, Larry, John, 00:42:25.260 --> 00:42:26.563 anything he missed there is going to get 00:42:26.623 --> 00:42:28.324 harder as we go along because he's covered 00:42:28.344 --> 00:42:28.864 a lot of bases. 00:42:28.925 --> 00:42:30.907 Anything you'd want to add to that? 00:42:33.340 --> 00:42:34.559 I'll just sort of, I think, 00:42:34.639 --> 00:42:35.800 amplify what Tim said. 00:42:35.880 --> 00:42:39.181 We'll see less diversity in PT. 00:42:39.340 --> 00:42:42.702 It'll be largely Caucasian, affluent, 00:42:43.641 --> 00:42:47.242 passionate people that maybe had a real 00:42:47.282 --> 00:42:50.862 positive experience in PT and debt to 00:42:50.922 --> 00:42:52.103 income sort of ratios. 00:42:52.262 --> 00:42:53.943 They don't even think about what that 00:42:54.103 --> 00:42:55.923 means for them because they have no debt. 00:42:56.923 --> 00:43:00.005 I think we'll see certainly a contraction 00:43:00.065 --> 00:43:00.764 in the number of 00:43:01.211 --> 00:43:02.311 of PT programs. 00:43:02.632 --> 00:43:04.092 There's just no way these smaller 00:43:04.193 --> 00:43:06.152 under-resourced programs will be able to, 00:43:06.552 --> 00:43:07.793 you know, I think, you know, 00:43:07.813 --> 00:43:10.313 survive in that scenario. 00:43:10.414 --> 00:43:12.635 So, you know, 00:43:12.835 --> 00:43:14.355 I'm always a glass half full. 00:43:15.014 --> 00:43:16.534 I think the crisis is in front of 00:43:16.594 --> 00:43:18.416 us, like literally as we speak. 00:43:19.235 --> 00:43:22.797 So I'm hopeful we can, you know, really 00:43:24.317 --> 00:43:26.217 you know hopefully eyes are opened uh even 00:43:26.257 --> 00:43:28.998 amongst the the those that are that have 00:43:29.018 --> 00:43:31.519 been most resistant to change and realize 00:43:32.099 --> 00:43:34.760 um uh you know without significant reform 00:43:35.141 --> 00:43:37.581 you know our profession is in uh some 00:43:37.601 --> 00:43:40.983 amount of of peril yeah all right larry 00:43:41.023 --> 00:43:42.643 no pressure but twenty thirty nothing 00:43:42.684 --> 00:43:43.425 happens yeah just a 00:43:46.001 --> 00:43:46.141 Well, 00:43:46.601 --> 00:43:48.762 I expect if you think there's twenty to 00:43:48.782 --> 00:43:50.605 thirty thousand shortage of PTs now, 00:43:50.625 --> 00:43:52.385 that'll increase five to seven thousand 00:43:52.445 --> 00:43:53.045 per year, 00:43:54.568 --> 00:43:56.289 notwithstanding because you have less 00:43:56.329 --> 00:43:58.530 graduates that actually practice clinical 00:43:58.550 --> 00:43:59.411 PT than ever. 00:43:59.931 --> 00:44:02.494 We will have less clinicians per year than 00:44:02.534 --> 00:44:04.195 we had prior to two thousand one, 00:44:04.215 --> 00:44:05.735 which is actually quite scary given the 00:44:05.775 --> 00:44:06.757 demand for PT. 00:44:07.097 --> 00:44:09.039 But the unfortunate thing is that PT will 00:44:09.239 --> 00:44:11.221 continue to be highly undifferentiated. 00:44:11.740 --> 00:44:14.802 Digital front doors and digital exercise 00:44:14.822 --> 00:44:16.563 will be conflated with PT, 00:44:16.802 --> 00:44:19.164 as will at-home remote therapeutic 00:44:19.244 --> 00:44:22.445 monitoring and YouTube. 00:44:22.545 --> 00:44:24.226 And so there'll be this bifurcation. 00:44:24.266 --> 00:44:26.088 If you've got money and you're young and 00:44:26.108 --> 00:44:26.608 you're healthy, 00:44:26.628 --> 00:44:28.208 you'll be able to access PT. 00:44:28.228 --> 00:44:30.130 But if you're sick and you're elderly, 00:44:30.530 --> 00:44:32.951 your access points for PT, my goodness, 00:44:32.971 --> 00:44:34.731 if you're in a long-term care setting or 00:44:34.751 --> 00:44:35.692 a home health setting, 00:44:36.172 --> 00:44:37.532 even in acute care setting, 00:44:38.032 --> 00:44:39.213 certainly neuro rehab, 00:44:39.574 --> 00:44:41.235 you're going to have a hard time accessing 00:44:41.275 --> 00:44:44.795 hands-on PTs and pediatrics is probably on 00:44:44.815 --> 00:44:45.677 that list as well. 00:44:45.996 --> 00:44:47.898 So the specialties are really, really be, 00:44:48.438 --> 00:44:50.259 be bludgeoned in terms of numbers. 00:44:51.398 --> 00:44:53.300 Those who are getting PT that are more 00:44:53.340 --> 00:44:55.101 into longevity and health and fitness and 00:44:55.141 --> 00:44:57.101 wellness are generally musculoskeletal. 00:44:57.802 --> 00:44:59.583 They'll fake their way into a conflated 00:44:59.623 --> 00:45:00.063 PT. 00:45:00.083 --> 00:45:02.103 That'll be a combination of a digital 00:45:02.143 --> 00:45:03.985 front door and YouTube. 00:45:04.005 --> 00:45:05.686 Yep. 00:45:05.965 --> 00:45:06.146 All right. 00:45:06.186 --> 00:45:07.126 Last thing we do on the show is 00:45:07.146 --> 00:45:08.447 called the parting shots. 00:45:10.577 --> 00:45:11.737 This is The Parting Shot. 00:45:12.277 --> 00:45:13.677 One last mic drop moment. 00:45:14.358 --> 00:45:15.139 No pressure. 00:45:15.599 --> 00:45:17.721 Just your legacy on the line. 00:45:19.500 --> 00:45:19.980 Pressure there. 00:45:20.039 --> 00:45:21.380 Today's episode brought to you by U.S. 00:45:21.420 --> 00:45:22.061 Physical Therapy, 00:45:22.081 --> 00:45:23.702 a national network of clinics focused on 00:45:23.742 --> 00:45:24.724 developing clinicians, 00:45:25.344 --> 00:45:26.105 not burning them out. 00:45:26.244 --> 00:45:27.545 Leadership tracks, mentorship, 00:45:27.565 --> 00:45:28.367 and career growth, 00:45:28.507 --> 00:45:29.467 as long as we have a profession, 00:45:29.768 --> 00:45:31.708 and the stability to build your future in 00:45:31.748 --> 00:45:32.090 PT. 00:45:32.150 --> 00:45:33.210 If you want a place that supports how 00:45:33.231 --> 00:45:35.311 you want to practice, that's USPH. 00:45:35.411 --> 00:45:36.393 USPH.com. 00:45:36.413 --> 00:45:37.994 That's USPH.com. 00:45:38.034 --> 00:45:38.213 Tim, 00:45:38.233 --> 00:45:39.735 you've done this before with me a bunch 00:45:39.755 --> 00:45:40.135 of times. 00:45:40.496 --> 00:45:41.476 You get to lead off. 00:45:41.657 --> 00:45:42.818 So what's your parting shot? 00:45:43.557 --> 00:45:44.940 Final thoughts, soapbox statement, 00:45:44.980 --> 00:45:45.400 what do you got? 00:45:46.724 --> 00:45:48.684 okay well i still love this profession and 00:45:48.784 --> 00:45:51.686 i still feel like from a societal 00:45:51.726 --> 00:45:55.186 perspective we have so so much to offer 00:45:55.367 --> 00:45:57.467 and despite the gloom and doomed said 00:45:57.487 --> 00:46:00.288 today uh i i still believe the future 00:46:00.527 --> 00:46:03.429 is bright and we just need to accept 00:46:03.809 --> 00:46:05.329 what's in front of us and just like 00:46:05.489 --> 00:46:08.751 you know we we have rehabilitated people 00:46:09.425 --> 00:46:11.847 We can rehabilitate our system. 00:46:13.086 --> 00:46:14.708 And so I'll leave it with that. 00:46:14.788 --> 00:46:17.108 It's time for some serious, 00:46:17.588 --> 00:46:18.909 deep rehabilitation. 00:46:19.710 --> 00:46:20.170 Love it. 00:46:20.210 --> 00:46:20.550 John, 00:46:20.590 --> 00:46:21.630 what do you got for your parting shot 00:46:21.650 --> 00:46:21.929 today? 00:46:22.791 --> 00:46:23.170 Yeah, 00:46:23.190 --> 00:46:24.550 I think I would just end with a 00:46:24.590 --> 00:46:26.032 little bit of optimism. 00:46:26.692 --> 00:46:28.231 There are some, you know, 00:46:28.251 --> 00:46:30.293 when I look at all the engagement on 00:46:30.652 --> 00:46:32.454 the initial post that both Larry and Tim 00:46:32.474 --> 00:46:34.454 did, there's some really well-informed, 00:46:34.934 --> 00:46:35.355 smart, 00:46:35.474 --> 00:46:38.735 younger entrepreneurs in our profession. 00:46:39.260 --> 00:46:42.163 that are probably hell bent and have ideas 00:46:42.202 --> 00:46:44.583 we haven't even thought about in making 00:46:44.623 --> 00:46:45.164 change. 00:46:45.425 --> 00:46:48.367 And, you know, that's where we were ten, 00:46:48.447 --> 00:46:49.786 fifteen, twenty years ago. 00:46:50.987 --> 00:46:53.309 And I'm very optimistic that those 00:46:53.349 --> 00:46:55.590 individuals are not going to take no for 00:46:55.630 --> 00:46:56.110 an answer. 00:46:56.731 --> 00:46:58.353 And they're going to you know, 00:46:58.532 --> 00:46:59.893 they're going to couple themselves with 00:46:59.913 --> 00:47:00.653 some mentors, 00:47:00.853 --> 00:47:02.034 whether it be us or many of the 00:47:02.114 --> 00:47:02.275 other 00:47:02.742 --> 00:47:03.021 you know, 00:47:03.061 --> 00:47:04.802 leaders in the profession that have done, 00:47:04.983 --> 00:47:05.824 you know, 00:47:05.864 --> 00:47:07.864 contributed to some significant reforms. 00:47:08.385 --> 00:47:09.065 And so, you know, 00:47:09.126 --> 00:47:13.409 hopefully that energy and youthfulness, 00:47:14.389 --> 00:47:16.731 you know, will thrive in a way where, 00:47:17.132 --> 00:47:17.572 you know, 00:47:17.592 --> 00:47:19.413 we'll see progress perhaps in a way that 00:47:20.014 --> 00:47:22.715 us gray hairs ourselves, you know, 00:47:22.755 --> 00:47:24.456 may not even be able to see ourselves. 00:47:24.476 --> 00:47:26.217 So, you know, 00:47:26.358 --> 00:47:28.840 so to any of those young entrepreneurs in 00:47:28.880 --> 00:47:30.460 PT, whether you're an academician, 00:47:30.501 --> 00:47:31.041 a clinician, 00:47:32.804 --> 00:47:33.204 you know, 00:47:34.027 --> 00:47:36.273 dare to dream and don't take no for 00:47:36.293 --> 00:47:36.673 an answer. 00:47:37.918 --> 00:47:38.800 All right, Larry, no pressure. 00:47:38.820 --> 00:47:39.541 You got to wrap this up. 00:47:42.112 --> 00:47:44.514 Well, while I share in my friends, 00:47:44.554 --> 00:47:46.856 colleagues and partners empowerment 00:47:46.896 --> 00:47:48.577 message that we do in fact have the 00:47:48.617 --> 00:47:50.920 ability to course correct here, 00:47:51.659 --> 00:47:54.222 I am also bothered by a serious data 00:47:54.282 --> 00:47:54.722 point. 00:47:55.063 --> 00:47:55.603 How many, 00:47:55.682 --> 00:47:56.824 if you just look at Tim and I, 00:47:56.864 --> 00:47:58.304 our kids are all older, John, 00:47:58.646 --> 00:48:00.086 your kids may still be in a way 00:48:00.106 --> 00:48:00.827 that they can, 00:48:00.867 --> 00:48:02.148 but how many will become physical 00:48:02.168 --> 00:48:02.708 therapists? 00:48:03.489 --> 00:48:06.271 And the reality is that most PTs when 00:48:06.351 --> 00:48:06.911 interviewed, 00:48:07.012 --> 00:48:09.273 do you want this career for your children? 00:48:09.413 --> 00:48:11.414 Absolutely unequivocally say no. 00:48:11.454 --> 00:48:13.675 The same thing happens for physicians as 00:48:13.715 --> 00:48:14.056 well. 00:48:14.757 --> 00:48:16.637 And so my parting shot would be a 00:48:16.697 --> 00:48:17.298 question. 00:48:17.478 --> 00:48:20.079 If the answer to your question is, 00:48:20.139 --> 00:48:21.842 do I want my children to become a 00:48:21.902 --> 00:48:22.782 physical therapist? 00:48:22.822 --> 00:48:24.983 If that answer is no, what action, 00:48:25.264 --> 00:48:27.545 what activities and what do we need to 00:48:27.605 --> 00:48:29.626 do and what are you willing to do 00:48:29.766 --> 00:48:31.768 and help so that you can answer that 00:48:31.807 --> 00:48:32.929 question in the affirmative? 00:48:33.528 --> 00:48:33.809 Wow. 00:48:34.110 --> 00:48:34.329 Yeah. 00:48:34.570 --> 00:48:35.230 Bold questions. 00:48:36.170 --> 00:48:38.572 We'll put the link to the series of 00:48:38.652 --> 00:48:40.413 articles that are going to be dropping 00:48:40.713 --> 00:48:42.032 throughout the next couple of weeks. 00:48:42.594 --> 00:48:43.594 Thanks for the insight, guys. 00:48:43.614 --> 00:48:44.375 We appreciate it. 00:48:44.494 --> 00:48:46.376 And thanks for setting a little optimism, 00:48:46.416 --> 00:48:47.675 then also putting some tension in the 00:48:47.695 --> 00:48:50.818 story because no pressure, no diamonds. 00:48:53.157 --> 00:48:54.237 That's it for this one, 00:48:54.498 --> 00:48:56.159 but we're just getting warmed up. 00:48:56.639 --> 00:48:58.541 Smash follow, send it to a friend, 00:48:58.762 --> 00:49:00.422 or crank up the next episode. 00:49:00.943 --> 00:49:01.543 Want to go deeper? 00:49:01.603 --> 00:49:06.349 Hit us at pgpinecast.com or find us on 00:49:06.409 --> 00:49:08.971 YouTube and socials at pgpinecast. 00:49:09.371 --> 00:49:11.652 And legally, none of this was advice. 00:49:11.713 --> 00:49:13.454 It's for entertainment purposes only. 00:49:14.114 --> 00:49:15.115 Bullshit! 00:49:15.135 --> 00:49:15.717 See, Keith? 00:49:15.936 --> 00:49:16.998 We read the script. 00:49:17.277 --> 00:49:17.938 Happy now?