There's the intro.
What do you think?
That's down the street.
I did a little time lapse.
Okay.
Nice, nice.
Because we're supposed to look over there?
No, look at me.
Most people aren't going to watch the live
stream.
I said most people aren't going to watch
the live stream.
They're going to listen to the podcast
anyway.
Rupa Patel is on the podcast.
No stranger to the show, Rupa.
Welcome to Anaheim.
Thank you.
This was my first CSM ten years ago.
Wow.
How many are you at?
What's your what's your CSM?
Probably around thirty.
Oh, really?
Yeah.
Missed maybe four or five.
I love CSM.
I think I missed one.
So this is nine or ten for me.
Favorite city for CSM.
What do you prefer?
Probably New Orleans.
Really?
Yeah.
You're going to go to San Antonio.
Yeah.
San Antonio.
But, you know, I'm from Texas,
so I go to San Antonio a lot.
I enjoyed New Orleans.
I enjoyed San Antonio.
Not that I don't like D.C.
It's cold, man.
And I like Southern California.
It's always fun.
It's not bad.
I have friends here.
Today's my birthday.
Today's your birthday?
Today's my birthday.
We get RuPaul on her birthday.
Well, happy birthday.
Thank you.
That's fantastic.
I got to go to Disney yesterday,
so that was fun.
What was on the hit list at Disney?
What was half to see?
They have a new Star Wars.
Did you do it?
Yeah, we went there,
rode in the Millennium Falcon.
I was one of the gunners, you know,
to try and defend the Empire, I guess.
Did you drop three bills on a lightsaber?
No, we didn't do that.
Smart move.
There were quite a few stormtroopers
walking around asking people for
identification.
We all thought that was a little...
what's going on in the world right now.
You're challenging PTs to confront
inequity,
engage in advocacy and become clinicians
for life, not just for episodes of care.
So let's start with this.
Why is the profession in an inflection
point now?
Because it's your birthday or are there
other reasons?
Why are we at an inflection point now?
Oh, well,
I think we're at an inflection point
because one, you know, we're still in,
I feel like we're still a profession
that's growing.
We've about a hundred years old, right?
We had,
we had a birthday a few years ago,
a couple of years ago.
And I think, you know, we,
we were born out of,
I call us an extra appendage of the,
um, you know, primary care physician that,
you know,
with the world wars and we took care
of soldiers and we took care of, uh,
you know,
after someone got injured and then now
what happens, right?
But now as we've evolved and now we're
in a doctoral, you know,
education standpoint,
now i think we really need to think
about how do we actually help transform
society in order to do that we have
to look at the big killers in the
world and not just treat people but like
how do we stop heart disease how do
we stop cancer how do we stop you
know a pain chronic pain and so to
do that we really have to go upstream
and we have to think about like those
kind of things so from education to
practice i think we're at an inflection
point
that we're evolving into our second
century as a profession and we really need
to think about you know our just our
mindset and our frame of like you know
who we are and what we can do
to transform society you know and not just
take care of people after an injury or
to prevent just a musculoskeletal injury
but to really manage you know lifestyle
and manage these chronic
It's nice to put on a wall.
It's nice to put on a t-shirt, right?
Transform society by optimizing movement
to improve the human experience.
And I get it.
Yeah, most of the words, right?
But how do you do that?
So how do social and structural
determinants shape outcomes?
That sounds like upstream,
downstream to me.
It does.
And, you know,
I think as physical therapists,
we don't necessarily focus on some of
those upstream factors because we're so
kind of focused on, okay,
here's the person with the shoulder injury
or the back pain,
and I've got to fix this.
But then we're sending them back in
environments where health happens,
where they work, where they play.
where they pray, where they're growing,
where they're going to school.
And so if those environments,
social as well as physical,
are not optimal for them to continue
sustaining what we did in the clinic,
we're not doing that patient any service.
They're going to be back in the system.
It's going to cost us more.
We're going to rehab them again.
They're going to go back into a system
and a structure that's not conducive to
health.
So I think screening for and addressing
those things.
I think a lot of people think, oh,
well, I'm not a social worker.
I'm not a psychologist.
That's not my lane,
but it's all of our lanes.
Again, if we want to transform society,
if we want to optimize that movement,
improve that human experience,
we have to kind of think about, okay,
what is the whole health of this person?
What is it that we're
trying to do here with this person not
just repair their shoulder or you know
knee pain but like okay they're working in
a factory and they're going to have to
stand all day well how is that going
to impact them i've rehabbed their knee
but can they stand for eight hours a
day uh with only two breaks and a
thirty minute meal you know and so i
think just looking at you know at those
things the structural and systemic things
are so important
And the data is so strong.
Like where you live determines your
mortality.
Like zip codes.
Yes.
And so it was Mark Milligan once the
first time he didn't invent it,
but like he pointed it out.
And I was like, yeah,
I'm asking people that I trust.
I'm like, is this true?
And they're like, it is so true.
And if we, and that same slide,
I still use that slide for Mark.
And he looked at like, you know,
in Austin, Texas,
where all the PT clinics are.
versus where are the populations that
actually have the health,
the biggest health disparities.
And there's no clinics on that side of
town.
What,
what on the other side of the tracks
meant, like it wasn't,
it's just not an ism.
It's a, it was the thing.
And I'm like, Oh wow.
And you can put, you know,
literally you can look at those maps in
every city and you see the same thing
that, you know, where's the care,
whether it's physical therapy or other
care.
And it's not in the, in,
in the places,
the zip codes where the population has the
most disparities and needs us, you know,
and,
I mean, that's true in Houston, too,
where I live.
And it's challenging because, you know,
the patients that need us,
we're not there.
So those structures and systems and then
zip codes, you know,
so looking at our patient's zip code and
saying, oh, you live here.
And then looking up, okay,
for that zip code,
what is the mortality and how is it
different than the clinic that they're
coming to?
And what do I need to do to
change or help the patient or empower the
patient?
So I think a lot of times we
think we have to be the one to
change their environment.
No,
we have to be the one to empower
patients to say, hey,
this matters to your health.
I can help you with this,
but now when you go back in this
community and you have
poor sidewalks, there's poor safety,
poor lighting, there's crime.
Those are the things that need to change
for you to continue to walk,
continue to ride your bike so that you
can stay healthy and not end up back
in the clinic, right?
And so some of that is a very
different way of educating ourselves and
educating our patients than we've done
like, okay,
go home and do your exercises kind of
thing.
Yeah.
Why is this statement
Apathy is more dangerous than resistance.
What does that mean?
Oh, my gosh.
Well, how do we dig into that?
Well,
I think if you're apathetic and you stay
home and you don't get out there to
advocate, then things won't change.
And, you know.
I feel like that happens a lot in
our profession.
That happens a lot in our country.
If you just look at elections and the
last time we had elections,
more people stayed home than who voted for
the winning candidate.
And so apathy, you know, and then,
then people are upset about some things
that are going on, but like, okay,
what'd you do about it?
Yeah.
Where were you?
I feel like apathy is more dangerous than
resistance because once someone becomes
apathetic and they're like, I'm out,
the chance of getting them back is super
low.
Where just resistance means like,
I'm still questioning you,
I don't believe you yet.
There's still a chance there.
But so like apathy leads to,
I feel like I'm trying to be Yoda
here,
like apathy leads to just disenchantment
and then you don't get a second bite
at the apple sometimes.
I'm looking around this CSM Expo Hall and
every second person is a student or a
new grad and they're bright-eyed and
bushy-tailed right now.
And how many will be gone in five
years?
Right.
They're super excited.
What can we do to prevent that?
Because once they become apathetic,
ounce of prevention, pound of cure.
No, that's so true.
That's a very good point.
And I think, you know, as an educator,
I really I want to be mindful of
that.
I tell my students all the time I
teach health policy right now, you know,
and like trying to.
think about them becoming advocates for
their patients and for our population and,
and like, versus like,
it's too hard and the resistance is
futile.
You know, that's Star Trek, not Star Wars,
but I'm a big fan of that too.
But yeah,
It's like, no,
empower yourselves so that you will have a
profession.
I always tell them,
I'm a little bit on the tail end
of my profession, but you're the future.
I advocate for the future and for the
future of our profession.
you're going to be working in the future
so you know advocate for that but i
think that's a tough sell sometimes
because there's so much information
misinformation disinformation out there
and people are just like i just need
to focus on what i'm doing with my
patient or in school and
I'll figure all that out later.
And then later comes and they're like,
whoa, I have low reimbursement.
I can't access my patients.
Why?
Oh, forget it.
I'm out.
I'm out of PT.
I don't want to be in here anymore.
I'll find something else.
And so it is.
I think it's an inflection point,
like you said.
We need to be better advocates.
And I feel good about, I think,
the next generation of therapists because
they
In their own way, you know,
they're finding ways to do that, you know,
and I think sometimes a little bit braver.
I mean,
I look at high school students here,
you know, in Texas,
like a lot of them walked out last
week, you know, and I mean,
in my school district, too.
And I'm so proud of them, you know,
for like standing up for their peers and
people in their schools that they feel
like.
you know, maybe we're not treated justly,
you know?
And so I think that's good.
You know, that makes me a little bit,
you know, hopeful.
Optimistic and hopeful.
Yeah.
I do want to say thanks to Steve
Cohen and Sarah Health for supporting the
podcast.
Remote care platform,
helping clinicians boost revenue without
having to add staff.
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through simple text messages.
That means no apps or a login for
me to forget, which happens a lot.
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Learn more at SarahHealth.com.
That's S-A-R-A-Health.com.
SarahHealth.com.
How can PTs advocate within their own
spheres of influence?
That is their network.
Because when you hear advocacy,
you think I'm taking a trip to D.C.
or Austin correct so how could they do
the advocacy thing this is fun without
getting off their couch or at a party
how do you how do you how do
you explain to do that yeah well it's
so many different ways I feel like and
I think APTA makes it a little bit
easier because we do have action apps and
you can sign up for news alerts and
you know you get information literally and
you just press it takes five ten seconds
to just press a button if you don't
want to make something personal
And advocate with your,
at least at the federal level, right?
And then I think the same thing,
the patient, you know,
like if they come to me and say,
hey, you know,
I'm not getting reimbursed for, you know,
this session or my sessions are limited.
And you're telling them, hey,
I can only see you for four.
And they're like, what do you mean?
I thought, you know, okay,
here's how you can advocate for yourself.
You know,
let's look up and see who represents you.
You can send a letter, you can call,
you can give them a little script, right?
And then there's lots of those things that
take very little time and you can do
it from the couch.
Phone calls, emails,
tagging on social media because
everybody's looking at that.
And then even with your insurance
carriers,
like a lot of times it's like call
them and let them know, hey,
why you think you need more care and
what's going on.
And, you know.
Be the fly in the ointment.
Yeah.
Squeaky wheel.
So I think there's lots of different ways.
But at the federal level,
I feel like the APTA, you know,
action apps and things that we have are
really helpful.
And it makes it easier for us to
do that.
And then, you know, with patients,
just empowering them, even saying, hey,
make a little video of like why this
is affecting you and send it to your
congressman or your state legislature.
Let them know, hey, I'm Mrs.
Jones and I live in this neighborhood.
And, you know,
I'm in PT with this person and this
is what she or he is helping me
with.
And I need more of that so that
I can do X in my home or
at work like that.
teaching patients to do that because
that's more powerful than me, the PT,
going to my congressman.
And it's larger.
There's a larger number.
Yeah, larger number.
Last question I'll ask sounds like a good
one.
What discomfort do clinicians need to
embrace?
Usually we say to avoid at all costs,
but that can't be the way, right?
So what discomfort do clinicians need to
embrace?
I think the biggest discomfort is kind of
thinking about looking at things
holistically, you know,
and that's uncomfortable because maybe
that's not what I'm trained to do.
That's not what I'm good at.
But that's what's needed.
Like that's what the patient needs.
That's what the community needs if you're
in the community.
So like embracing that discomfort and then
putting yourself out there a little bit,
learning, of course.
You know, as clinicians,
we know where to look for good
information, evidence-based, who to go to,
networking with people who are in those
spaces.
And we need to embrace that because,
again,
it's about improving that human
experience.
And if we're uncomfortable with a patient
who is just like,
psychologically depressed or has other
symptoms and you're like oh my god okay
go see a psychologist first not me come
back and see me after that's done right
like that's because that's uncomfortable
for me I haven't done that with many
patients and so then first is like okay
tell me more I may not be able
to help you Jimmy but I want to
listen and see
what we can do together.
And if I can refer you to someone
or something like that,
so that's uncomfortable,
but that's so important.
And that'll earn us the trust of that
person, which is,
which is the game we're in,
which is the game we're in.
And then opening up a conversation that,
you know, they, they're probably thinking,
you know what, she's going to ignore this.
Like she's, you know,
she's just going to focus on this,
but that when you do,
then you earn that trust and then you
get into some things that maybe are really
important, you know,
and that will improve their human
experience,
which I think is what we're all about.
We have a Trish on the show.
It's called The Parting Shot.
This is The Parting Shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
You got to drop the mic.
Do you want to say thanks to U.S.
Physical Therapy?
We're at their booth right now at CSM.
Thanks, USPH.
Thank you.
Network of clinics focused on developing
clinicians across the country,
not burning them out.
With leadership tracks, mentorship,
career growth, and long-term stability,
USPH supports PTs who want to build
futures in this profession.
USPH.com.
It's USPH.com.
So what's your parting shot, RuPaul,
for pressure?
My hat.
There's no pressure, right?
No pressure whatsoever.
We keep it low.
Yeah.
I think my parting shot would be like,
you know, it's very cliche, but, you know,
I am an immigrant to this country from
India.
And so things that Mahatma Gandhi has said
over his lifetime are so like part of
who I am.
And really,
I think all of us need to be
the change we want to see in the
world.
And it seems really cliche.
But like, if you really think about it,
like all of us can do that in
some form or fashion.
It doesn't have to be big.
And you don't have to be a person
in a powerful position or anything like
that.
The Mahatma was just a simple man,
and yet he freed a country and led
a resistance.
And so you don't have to be a
person in power or position to do great
things.
You can be that human being that can
change the world.
Rupa Patel, happy birthday again.
Thank you.
Thanks for stopping by here at CSM.
Yeah.