She's like, I'm in bed.
The best conversations happen at happy
hour.
Welcome to ours.
Welcome aboard.
This is the PT podcast.
Here's your host, physical therapist,
Jimmy McKay.
Good timing.
Live from CSM.
Twenty twenty six here in Anaheim.
Want to say thanks to Empower EMR.
If your clinic is stuck with an EMR
that's slowing you down,
that's your choice.
That's your choice.
You chose that.
You can also choose a way out.
Designed for PTs.
Better notes, faster documentation,
smoother operations.
I always yell, smooth operator,
whenever I say that.
All wrapped up in customer support doesn't
ghost you.
Upgrade your clinic's brain with Empower
EMR.
Visit empoweremr.com.
In a profession obsessed with
specialization,
our next guest is here to make the
case that being a generalist isn't a
weakness, it's preparation.
Ben Lindeman, welcome to the show.
Thanks for having me.
Appreciate it.
Where are you from, man?
I live in Philadelphia.
nice yep right now where this little
shindig will be next year yeah yeah i'm
right down smack down the middle of the
city in the convention are you from pa
uh born and raised in iowa but then
moved out to pa for grad school and
then just never left fantastic all right
so uh there was an oxford debate a
couple years ago at generalization versus
specialist uh it was very interesting as
oxford debates which should be brought
back to the apta that's a hill i
will die on and i'll keep pitching about
until it gets brought back um and it
was interesting to hear both sides yeah
We like chasing things like titles and
specializations.
It is neither good nor bad.
It just is.
So why do PTs feel pressure to sort
of specialize or do these things?
I don't know.
I think it's a couple things.
I think if you, like,
zoom out and just healthcare in general,
like...
physicians like everyone has a specialty
and I feel like every time I have
patients they're like yeah I have to go
see the ortho guy but then he specializes
in the knee and then it's only the
right knee but not the left knee and
I think it's just how our health care
is designed from a top-down approach and I
think it's just trickled into PT and
there's a time and a place like I
have my neuro specialty I'm not here to
rag on it but I think just so
often I hear oh you need to go
see Ben he's the neuro guy he's the
neuro guy and I'm like
People are people.
You don't necessarily need to have the
specialization to provide best care for
them.
I get people know me because I have
a podcast.
And people are like, he's the podcast guy.
And I'm like, actually,
I have a degree in communications and
journalism.
So I could do words, too.
Or I could do pictures.
Or I could do a combination of both.
So yes, you might be a neuro PT.
You're still PT and there's a time and
a place and neither is better or worse.
But where does that pressure come from?
Is that is the call coming from inside
the house?
I feel like it's like patients like some
want that specialization because they feel
that they're going to get better outcomes
because of it.
So I think it's a patient
customer service based marketing thing.
I'll take credit.
Yeah.
Shame.
Yeah.
And then I think it's, you know,
people want to have that identity of like,
I have this thing that nobody else has
or very few people have.
And so then it promotes this level of
autonomy that you maybe don't have as a
generalist or in that sense.
So I think there's
like talking about in absolutes,
like it's just patients or just therapists
or just administration.
Never is.
No.
Yeah.
But yeah,
it's just one of those things that it
was always kind of annoying when I was
in full-time clinical practice was like,
You know,
I would just get all these people like,
oh, Ben, you're the neuro guy.
I want you to see this person.
I'm like,
did you even do anything with this?
Like, did you eval them?
And they're like, well,
I don't have like you have skills like
you graduate as a generalist and you like
very few times I had to like truly
dig in with my neuro knowledge and like
to provide care that that probably that
therapist could have done.
But I'm like,
ninety percent of what this person needed
was just basic attention or a set of
eyes,
all those all those different things.
What do we lose when we undervalue a
generalist?
I mean, here's the thing.
We're at APTA.
Fifty state chapters.
Eighteen components.
None of the components.
There's pediatrics, geriatrics,
orthopedic sports.
There's no academy of generalists.
I know.
So maybe it's a little bit of like,
well, if I don't belong somewhere,
I don't belong.
And I think they're trying to probably
funnel that population into the new
primary care and specialization stuff.
Oh, that's a good point.
Yeah.
So to me, I view the primary care,
this is my own thought,
it's like you're kind of now a specialized
generalist, if that makes sense.
Now we're just going in circles.
Now we're just talking in circles.
I mean,
it's just also like I enjoy the variety.
I enjoy working with people with
neurological conditions,
but I love treating my runners.
I love treating, you know,
anybody who has a pulse.
Really, I'm happy to work with them.
So well said.
So how does value based care change this
type of conversation?
That's a tough one.
So I think.
You have to define,
like how would you define value though?
Like what does that mean to a payer?
What does that mean to the consumer?
What does it mean to me as a
therapist?
And probably all answers are different.
Yeah.
They have to be.
They will be.
They have to be.
Yeah.
So I don't know.
I haven't really given that one too much
thought.
But I think it would be kind of
understanding or triaging or better
triaging like who is truly going to
benefit from a specialized individual.
And I was, before I came on,
I was like looking into some research and
there is at least some research to
support.
Yeah.
If you have like F and D or
something that's really, really niche,
then yeah,
you're probably going to be best off with
somebody who specializes.
Cause some of this stuff is coming out
of Australia.
They're putting a lot more research into
this idea of generalist versus specialist.
And they're basically just saying, yeah,
like you may need a specialist for like
certain very niche things,
but probably you don't need it for
everything.
Yeah.
I mean, it's probably like a bell curve.
Yeah.
There is an extreme on either side that
will need it.
And then there's the middle of the bell
curve and that's how bell curves work.
Yeah.
Crazy.
It's nuts.
Yeah.
Um,
Why is generalist thinking critical in
rural and primary care settings?
Because you might be the only person
within
hundreds of miles or months.
Yeah.
The only person in health care.
Yeah.
And so having that adaptability in that
range and that depth of knowledge is
you're it.
So because these people may not
necessarily have specialists with access,
even with telehealth.
So having that really strong generalist
mindset, I think, is what's needed,
to be honest.
And so many times it's just
Yeah.
I had a patient last week who was
like, yeah, I went to this physician.
I went to this physician.
I went to that physician.
Now I'm back in PT.
And I was like,
you just went to twelve physicians and
still aren't anywhere near where you need
to be.
So, yeah,
I think generalists are what's needed,
especially in those settings for sure.
You can't walk more than ten feet without
running into a pack of students at CSM.
Yep.
It's a constant question from,
I don't know, second grade.
What are you going to be when you
grow up?
And then you get close to college.
What are you going to major in?
And when you're in PT,
where are you going to practice?
It's constantly what is next.
Yeah.
So...
how would you speak to a younger clinician
talking about identity and scope in terms
of generalists during specialists?
How would you,
would you tell them to slow it down?
Would you tell them to,
what would you tell them?
So my path into PT was I graduated
then went right into a neuro residency.
And I think that,
accelerated my thinking in some aspects
but i think it really put me in
this kind of pocket of all right this
is all i'm doing and this is all
i can do and then once i actually
got out into practice full time it's like
i actually kind of like more of the
generalist thing so i for a younger
clinician i think you know try it out
like pt is such a versatile profession
where you don't have to be a specialist
like you know a physician going from med
school to residency
Um, so like, yeah,
take the first couple of years,
like work in a place that's going to
have lots of variety, right?
Whether it's an outpatient,
whether it's impatient, whatever.
Um,
and not feel pressured to feel like you
need to define who you are right when
you leave PT school.
Cause I don't think that's,
it needs to be the case.
You get one PT license.
Yeah.
And, uh,
when you want to go from piece of
geriatrics or there's no,
there's no toll booth.
Yeah.
There's no one saying you have to have
this thing.
And that's a little, it's, it's awesome.
Yeah.
I went from sports outpatient to peds,
and I was sort of like waiting for
someone.
I was looking to get pulled over.
I was like, where's the cop?
And they're like, there's no cop.
You can just do that.
And that's, I think, part of our strength,
but also maybe part of our weakness when
it comes to explaining to people what we
can do because you're a PT.
Who do you work with?
And you're like, okay,
so I could work with this to this
to this to this.
So it is a strength,
but it's hard to explain a profession to
people or the many possibilities.
For sure.
A hundred percent.
would you say to a pt who feels
less than for not specializing how would
you make them i feel like we need
like soft music like okay sit down look
right into my eyes i don't know like
where is that thought coming from though
like where who put that in your head
that you needed to specialize or that you
need to do that like
So I would want to tell that person,
well,
you need to get new friends because that
thought didn't come from just organically
probably.
But I think you then just go back
to your patient outcomes.
Are your patients getting better even if
you're not a specialization?
Do you like doing this?
Yeah.
And then is this satisfying to you?
If you hate neuro and want to be
a neuro specialist, then that's on you.
Yeah.
Yeah,
I think there are people that love
specialization, and that's their jam,
and I'm not here to rain on that
parade.
But I think it's just my clinical
observations and just seeing that it just
organically happens where people get boxed
into these...
profiles or demographics.
And I think it just really then is
challenging for younger clinicians because
then people just keep getting triaged.
And then you never fully develop a skill
set because younger clinicians would be
like, oh, Ben,
I want you to see this person with
a stroke.
I'm like, well,
you can still learn from this person.
And now you're just really limiting your
ability to work with all sorts of
individuals because they get scared or
they're not confident.
And I'm like,
you can still do the basics really well.
And then, yeah,
if the patient's not getting better,
then potentially triage or something like
me.
Yeah.
But so many people just punt the ball
so quick.
And I think that's just limiting your
growth.
That's internal, right?
That's our own problem.
I'm guilty of it.
That's why I can spot it.
Guilty of myself.
I'm not the expert in this.
But I heard someone smart say,
most of the time because only the sith
speaks in absolutes i learned that from uh
star wars uh most of the time you've
gotta you don't need to be the world's
expert
on anything.
I've never been the world's expert on
anything.
We need you to have enough expertise to
speak confidently and competently.
Confidence and competence is sort of the
ticket you need.
And then when you realize, hey,
spending more time with me will probably
be a disservice,
that's when you do that power move,
which is a handoff, when you notice that.
Last thing we do on an episode,
we call it the parting shot.
This is The Parting Shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
No pressure whatsoever.
So you can have your own parting shot,
or I can give you a parting shot
prompt.
Let's do the prompt.
Prompt.
What's one mindset shift physical
therapists need to make about their
clinical identity?
That'll be your question.
What's one mindset shift?
I feel like you've said it a few
times.
Yeah.
I think you just need to...
know just eliminate the noise around you
and like don't be influenced by what your
boss wants you to do necessarily or what
other people are doing around you like
find what you want and make that your
identity and if you haven't found it keep
looking yeah yeah and if you need a
place to look that's good too you don't
know where to look uh come to an
event like this yeah and just
Listen, look, consume,
figure out what you like,
and then take bits and parts of your
favorite things that you see and make your
own thing.
I'm a physical therapist radio DJ.
I literally just made this up.
You just make things up.
You're an N of one, right?
Yeah.
I would have loved for some help along
the way or like a guidebook,
but you can just do things.
Yeah.
And that's how things happen.
Well, and it's part of the growth.
Like, you know,
the struggle and making mistakes and
trying to figure it out,
like that's part of the journey.
Yeah.
what I like about it the most.
Listen, I'm here for a good time,
not a long time.
Ben,
appreciate the stop by here at APTA CSM.
Here, in.