Thank you.
We'll give you the jazzy music.
All right.
Advocacy is not optional.
It's either something you do intentionally
or something that happens to you.
It feels like maybe it's like getting hit
by a truck.
You're jumping over the truck.
The truck is jumping over you.
Our next guest has spent decades inside
this machinery of health care policy and
professional advocacy.
Live from Anaheim, Jim Leahy.
Jim, welcome to the show.
Thanks, Jimmy.
Great to be here.
How's this little conference,
this little shindig going for you so far?
You know, I love CSM.
Yeah.
It's a big party.
It's great people.
You know, we get to see, you know,
clients of ours from all over the country
in one place for a whole week.
And, you know,
you get to know people better.
Yeah.
And PTs are people.
Yeah.
Persons.
Yeah.
And this energy,
you hear a lot of energizing,
refilling the battery metaphors and
analogies.
And that's what it is.
It's really important to remember what
fills your cup in life.
If you're just running hot all the time,
you're going to run out of gas.
This is the kind of stuff that reminds
you why you work with these kinds of
people.
So you're not a physical therapist?
I'm not.
But you've been in this profession.
What was the award last year?
Honorary member of APTA.
I've been involved with APTA chapters
since
And I'm not licensed,
but I can diagnose occasionally.
And they don't hand that out.
I feel like that title doesn't really,
it doesn't sound as heavy as,
they don't hand that title out to people.
My understanding is there are about twenty
of us.
Yeah, that's a pretty good list.
It was humbling.
I have to be honest.
It was one of my dearest friends on
the planet Earth, APTA folks.
And when I got the call,
I was speechless,
which doesn't actually happen to me very
often.
I can attest.
I've talked to this guy a lot.
There are a few people who can talk
as much as me.
This is one of them.
It must be the Jimmy thing.
So give people context.
Not just a title of what you do,
but how do you describe what actually gets
done?
You work at a high but tactical level
with state chapters.
Yeah,
so I'm the managing director of a public
affairs firm based out of Boston.
And, you know, in my professional career,
I kind of started as a lobbyist and
a nonprofit manager.
And when the APTA thing started back in
ninety two,
I was the lobbyist in Connecticut.
A couple of years later,
they asked me to be the executive director
and it worked out.
And then not intentionally,
but we slowly started acquiring chapters
in the Northeast and we learned some stuff
about how to work together.
You know that a good friend of mine
wrote an article back in nineteen ninety
five about organizational development and
whether organizations are egocentric or
everything had to run through them or
network centric or just creating
opportunities for people.
And we've developed the latter model.
We have regular gatherings of like our
presidents and they and they really become
friends and it's a support network.
I think one of the first times we
had done a project together was during
COVID when someone had emailed me and they
were like,
you know how to do a live streams.
And we got this conference that now can't
be in person,
but I feel like in the Northeast,
I did hear a comedian say this,
it looks,
I know that the United States was settled
East to West,
but it looks like it was done the
other way.
And we just ran out of room and
started designing States of the Northeast,
just look like puzzle pieces.
But I feel like out of proximity and
geography,
the states from Maine, New England, Maine,
down to where I am in New York,
wind up doing things together.
It's easier.
Yeah, it's easier.
Right.
It's just easier.
And, you know,
when education and meetings moved to more
virtual,
those geographic lines got less important.
Didn't matter.
And that's what enabled us to expand
beyond New England.
Now we work with Minnesota,
Colorado and South Dakota.
And to be frank,
I've had a bunch of conversations this
week with other folks who
You know,
I'm not under any delusion that it's us
they want to be with necessarily,
but they see how our presidents work
together, how our chairs work together.
And those kind of support systems are
really important when you're in battle.
And legislative battles are battles.
With words.
Policy and words.
And because that's my lens,
because that's where I come from,
I enjoy taking times to teach people about
advocacy.
And it's like everything else.
Many hands make light work.
And if PTs would engage at the same
level that chiropractors do,
we'd be stronger than chiropractors
because there are more of us.
But we don't.
Lots of PTs think differently.
they can delegate their advocacy
responsibilities to other PTs,
and it's not how it works.
Yeah,
people will never talk about your goals or
visions as often, as passionately,
as accurately.
When you farm that out,
you lose something.
It's funny.
People are intimidated by talking to
legislators.
And one thing you learn when you deal
with legislators a lot is they're not very
intimidating.
You know,
often they're the most popular person in a
room at a meeting when they were trying
to decide who'd run for office.
And very few of them are physical
therapists.
So you have something to bring to them.
Yeah.
You know,
it's frustrating for me when I go to
a state day on the Hill and it's
eighty percent students.
Yeah,
because that sends a bad message that says
the legislators that we sense we sent
students and nobody else showed up with
them.
With that said,
Physical therapists who commit to advocacy
can be very good at it because it
doesn't matter why you care about
something.
The question is why should the legislator
care about it?
Why is it good for their constituents?
Why is it good for them politically?
And so we're used to talking to patients
that way.
I can't just dump what I know on
you.
You're not going to be a compliant
patient.
I need to explain why you need to
do it.
Understanding.
Yeah.
So in your role, I mean,
a lot of people,
when you go to APTA Minnesota,
APTA Connecticut's website,
it looks like the highest ranking person
on the association is the president.
The president is elected and serves a
term.
They're usually a physical therapist or a
business owner,
but you're sort of the structure that
remains from administration to
administration.
What do you sort of provide?
What are the things that people don't know
is being provided by it.
Yeah, we're the infrastructure, right?
So we do board development,
leadership development.
We work on communications.
We try to figure out how to help
them reach their goals.
And because we have experience,
we've seen where it works and where it
fails.
So you can sort of be in a
room and be like, sort of, no,
I see what you're trying to do there,
but we've done that,
and here's three reasons why that might
not be as effective.
And usually what it comes down to is
tweaking stuff.
Yeah, so it's not far off.
It's just two degrees off.
I am a lifelong committed optimist.
And my staff often roll their eyes at
me because I'll say, oh,
we can do that.
And, you know, it takes a little work.
But if someone's passionate,
if you get people to really work,
you know,
a team to work in a direction,
you can accomplish incredible things.
You know,
I spent my life as a soccer coach.
And the compliment that I got from players
most often was that I made them believe
they could achieve something that they
never thought they could achieve on their
own.
And I feel like we do the same
thing with therapists often.
Like they didn't think they could be a
good lobbyist.
So what's the pitch to someone who's like,
that looks like a lot of work and
I'm not, I got twenty other things.
Like what's sort of your way of getting
them to take one step and then showing
them that that one step wasn't that bad
and why not take one more?
Yeah, well two things.
One is we develop tools to make it
easier.
Good.
And then reminding them that it doesn't
matter what you learned in school and it
doesn't matter what you know how you can
do.
State legislatures determine what your
scope of practice is.
And if you're interested in sitting it out
and hoping they make good decisions.
Let me know how that works out.
You're a knucklehead.
Yeah, you're just a knucklehead.
I actually have been lucky enough to pass
three first in the nation state laws.
Oh, wow.
Fun one.
Warning,
small parts may pose choke hazard.
Those are you?
It was me.
Wow.
Nineteen ninety one over the objection of
Lego.
And actually, in this very building,
celebrated the success passing the first
GMO labeling law in the country,
which later got struck down by the feds.
But you can achieve some pretty cool stuff
if you get committed groups of people
together.
That Margaret Mead quote, you know,
don't underestimate what a small group of
committed people can do.
It can change the world.
It's the only thing that ever has.
And so...
Like,
I don't know why you'd spend as much
money as people spend on a PT education
and then hope that they let you do
it.
It doesn't make any sense.
And the one thing we know about politics
is it's not a lot of work at
any given time.
It's just over a long period of time
because it's about relationships.
Correct.
The question is,
when a legislator is faced with an issue
around this stuff,
are they reaching out to you?
And if you spend enough time developing
the relationship, that'll happen.
And it doesn't mean you have to go
to Boston or Hartford or Denver or St.
Paul.
Go to the coffee house in the district
where they're having an open town hall or
just an open office hours.
Just have a conversation.
They're interested in what you care about.
You know,
when you get to the legislature and
there's advocacy sides on both sides,
it's knock down, drag out.
Right.
And it really does help if they know
you and trust you.
It does.
And you have to be willing to tell
the truth,
even when the answer is uncomfortable.
The legislature says, yeah,
your houses can impact you.
Don't exaggerate.
Because they'll figure that out.
I know legislators who will ask a
difficult question on purpose to see how
you answer it.
Oh, that's smart.
And if you lie, you're done.
Because they're judging your character.
Absolutely.
If I ask this person later a question
I don't know the answer to,
am I getting the truth or not?
In Connecticut last year,
we wanted to pass mandatory ethics CE.
So we have a CE requirement already.
We just wanted two hours of that to
have to be ethics because with the
pressures from health insurance these days
and long hours and burnout that we see
in our profession,
we know that reminders of some ethical
standards and some even tips and tricks to
take pressure off yourself is really good
for a therapist and creates the
environment that we want,
a healthy practice environment.
FSBPT recommends it actually.
I took one conversation with the chair of
the committee
who's a social worker who we talked to
a lot.
And as soon as we said it,
she said, you're right.
And she put it in the bill and
we actually never had to lobby.
Wow.
Like because we developed the relationship
and Vic Vaughn,
who's the former Connecticut chapter
president is a constituent of hers.
He's taken a ton of time with her.
Uh, and you know,
we didn't sell a bill of goods.
It was the right thing to do.
And it worked.
Yeah.
Some things because again,
you work across states.
So you're seeing things on a state level
across states in different time zones and
everything.
What's what's one or two things you're
excited for that hopefully we can get to
to change at a state level or several
state level in the next three to five?
I think APTA's renewed focus on payment is
really important.
I urge my chapters not to call them
legislative committees anymore because to
a carpenter with a hammer,
everything looks like a nail.
The legislature can be the worst place to
make change sometimes.
Because what,
you have to do it before that?
It's just long.
Legislative is a long process.
Nothing passes the first year.
Well, our ethics bill did,
but generally nothing passes in the first
year.
But if you look at things through a
bunch of lenses,
there are administrative changes that can
happen.
There are legislative changes that can
happen.
You can work directly with insurers to try
to come up with pilots and other things.
We're seeing some interesting AI
applications now.
There's a brace up in Massachusetts that's
created AI to fight with the insurance
company computers and then tells you when
you should pick up the phone and call.
It's all good.
So I think the focus on payment can
really help because we need,
if the environment that we're in now
continues, it's going to be problematic.
And I think we have to approach it
from a bunch of different angles,
making our people smarter and doing stuff.
I think there seems to be some,
some movement on prior authorization laws
now to make that, you know,
we know that making it harder for people
to get treatment ruins outcomes and makes
them more expensive.
And I think people are starting,
finally getting that.
So I think we're going to keep seeing,
I mean,
APTA does a great job
telling people how important this is and
trying to provide resources.
No question about it.
And we just need people to not think
it's optional.
Like it's just part of your job.
And if you're not doing it,
you're letting down your patients.
You're free to do it yourself.
You don't have to take advantage of it.
But your patients don't get access to your
care.
That's not cool.
Yeah.
Last thing we do on each episode is
called the parting shot.
What's one idea, concept, quote,
mic drop moment?
What would you want to leave with
everybody as we wrap up?
Yeah,
go on your state chapter website today,
look up an issue and send a note
to your state representative in your state
center and do it before five o'clock
today.
This live stream is twelve minutes long.
You could probably said several of those
in the time it took to listen to
this.
And I know it.
I know it probably feels like it just
goes into the abyss or some email address.
I got a buddy who's a district state
legislator in New York,
and he showed me the spreadsheet.
He's like, every email comes in,
and we have people who email often,
and he's like, I recognize the names.
He's like, this person's got a soapbox,
but he shows me every email.
So someone's reading it,
and not only reading it,
but taking it out and putting it on
the spreadsheet to show which topics are
coming up most often.
When I started lobbying for the
Connecticut chapter in nineteen ninety
two,
I spoke to a Senate chairperson of a
committee and he told me two things.
One was that the chapter relied too much
on its lobbyists and it needed to get
more PTs to the Capitol.
So we've taken that to heart.
The second, I said,
how much does it take?
And he said, we notice every one.
If it's two,
there's a staff person who's looking at
it.
If it's five,
we have to have a position.
And if it's ten, the revolution is coming.
Ten.
And a Senate district in Connecticut is
about, I think it's eighty thousand,
is that right?
I think that's right.
Ten.
Ten emails.
Ten.
Now,
there are issues where that comes out.
differently like if it's something that's
on the front page of the newspaper or
in your in your you know seven a.m
news broadcast it's going to take more
than ten right most of the stuff we
work on can get you noticed damn ten
in connecticut passed pt compact
legislation a few years ago we generated
letter emails to probably twenty five
house and senate districts from where our
committee leadership was
And that committee chair referenced that
at every public meeting throughout the
legislative process.
And when it passed, she said,
we knew we had to do it because
legislators cared and legislators cared
because they heard from constituents.
All right.
Well, hey,
optimistic about all the states that
you're working with.
Appreciate your time here at CSM and good
to see you, man.
Thanks, Jimmy.