Here we go.
I'll give a quick intro.
All right,
live streaming from CSM in Anaheim.
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SarahHealth.com.
It's SarahHealth.com.
S-A-R-A,
like the girl in your middle school class.
It's Sarah without an H. Sarah.
S-A-R-A.
Health.
He's a private practice owner,
legislative advocate,
and president of APTA Massachusetts.
After more than twenty years treating
patients,
now he's working to strengthen the future
of this profession through advocacy,
leadership, and action.
Steve Smith, welcome to the show.
Thank you.
Great to be here.
This is a pretty cool party.
It is.
How many CSMs deep are you?
Do you know?
I think this is eleven.
Oh, that's good.
Yeah.
When did you graduate from PT school?
Oh, two thousand five.
OK,
so when did you catch the bug of
like, do this thing?
Because this isn't a normal.
We had it in Boston.
Oh, that was.
So we had in Boston the second year
out and it was like, oh,
this is a cool party.
Thank you for the coffee, by the way.
We just went and hit the coffee booth.
My pleasure.
And yeah, it's when I could afford it.
That's what I would go.
Yeah, as early career wise, as you should.
Right.
And I think they try to do a
good job.
People, you know,
will will complain about, well,
why is it in this city,
in this city?
And then they just like literally just
like, where will you put nineteen?
It needs to have a big enough like.
Not just a big enough city,
but a big enough city built around a
conference.
Like,
show me where you'd put all the people
and where they would sleep.
And some cities are built for that.
And you'll see the New Orleans' and the
San Antonio's and the San Diego's and
the... Sorry, the Anaheim's of the world.
Right.
And the Boston's of the world.
Yeah.
So you do both...
Clinic owner, you've done that.
And chapter president,
I mentioned in the intro.
What made you step into advocacy and
leadership roles?
Because both of those are, by default,
leadership and advocacy roles.
What was sort of the bug for you?
I caught the ownership bug when the clinic
I was working for got bought out by
a venture capital group and didn't
necessarily like the direction it was
going to go.
So I wanted to continue to treat community
health
and found a partner and found a space
in a community I love and went from
there.
And so that organically has been
great and rewarding, but it's been super,
super challenging.
And I also didn't know leadership was also
a skill you have to learn.
I just thought, I was like,
I've managed people.
I know these things.
I know how to tell people things and
how to do them,
and they'll just do it.
Right.
Turns out, it's not the case.
So then during COVID,
had to rethink a lot of things.
Then I started asking questions.
Questions about like,
I've always been an APCA member,
so what...
are we doing here um we started getting
some good guidance from our president two
past presidents ago eric fulmar and he
really did a great job guiding our ship
through um a lot of the legalities of
the shutdown and so really helping us get
back open helping us do it safely and
you know not losing the clinic at the
same time so that was huge terribly
important yeah so you literally said i
don't like where this is going
I'm going to do it myself,
which is simple to say and not easy
to do.
Let's play that whole game of what do
you wish you knew then that you know
now?
What would you have told yourself?
What landmines did you step on that maybe
you could have avoided?
You know,
I don't know if there's anything that you
can do when you're having the issue with
something like COVID comes up.
It's unprecedented.
Once in a generation.
Hopefully.
I wish I had asked questions earlier.
And that's really my big thing.
I just was a member.
I didn't ask what, you know,
could be done.
What can I do to help?
Yeah.
In what ways?
Like, what are we working on?
I just kind of went with the flow
and then you're like, all right,
so payments not going the right way.
So we're not getting good news on this.
We're not getting good news on that.
So you're just sitting there accepting.
Right.
And that's something I just as I got
older, I'm like,
I just don't accept this anymore.
Right.
So how do we actually try to make
a change?
Yeah.
So that's where I came from.
Yeah.
People are the life hack.
People write things.
People still write the thing.
People are on podcasts.
It's still a people thing.
And most of the time when people do
things,
they like when you ask them questions
about the thing that they've done.
Right.
But they like that.
Yes.
Like I told the story a couple weeks
ago how when I was in PT school,
second career student.
So I sort of.
picked up a few life hacks along the
way,
and realized I do this big paper in
neuro, and I'm not a huge,
I don't like reading research.
My brain doesn't brain.
Some people are good at it, I'm not.
So I just called a person who had
written a book on the topic that I
was researching,
and she talked to me for an hour,
and explained everything,
I understood everything,
and then she gave me a Google Drive
full of the stuff I should have been
reading.
And I was like, well that was easy.
You can do that.
That's your skill.
That's right.
But anybody can do that.
That quite literally costs zero dollars,
just an hour and a half of my
time,
and it gave me everything that I wanted.
Absolutely.
You've said that, I love both statements,
every PT and PTA needs to care about
advocacy, payment, and access.
Why is that so critical now?
Why is that important now?
It's always been important,
but I do think now with the...
Tuition never decreases.
It's going to go up.
Right.
It's going up every year a certain
percentage.
Our pay is not going up every year.
In fact,
we had six years of Medicare devaluing our
services.
So now we did get a recent win
this last year,
and we are sitting at the table this
year for federal payments through
Medicare.
But...
We just can't sit there,
get more education,
raise our practice level,
and then not get reimbursed or paid for
that.
Everyone's waiting around.
I feel like a lot of people wait
around for somebody else to do something.
And it's not,
nobody else is doing anything for us.
So you can join an association,
you can remain on your own,
but at least the point is like,
know who your legislators are and just at
least reach out because they're humans
too.
And they love a conversation with their
constituents.
So just being active and then at the
very minimum,
push for something like in Massachusetts,
we have our scope of practice bill.
That's going to fundamentally change
prescriptive authority and our ability to,
um,
have diagnostic imaging.
So with those two new permissions,
it opens up a whole new can of
worms for us.
And it's great.
And if we really push that as a
profession, not just an association,
we have a chance of making something
really good happen in Massachusetts.
And when a domino falls,
it'll help hopefully fall somewhere else.
Exactly.
It's the beginning.
Right.
So it leads to changes in payment.
It leads to us getting a seat at
the table with third party payers.
advice for someone who's hearing this
going but i don't really understand
advocacy i understand the process i just
want to lower anxiety like people can just
show up and just like help right like
fold chairs or pay attention or be on
a call you don't need to run a
committee on your first day like that's
not how it starts right right and i
think what we're learning is that we had
a huge education gap for that first step
there's there's education on once you're
in it how do you advocate better how
do you do this better but there was
no
soft first step off the bus or onto
the bus to get going with it.
So, you know,
trying to put out an educational program
for our members that would really help
people to take the first step.
Why should you care?
What are we caring about?
And what do we do?
So yeah,
somebody else coined this sort of this
idea.
It's called the grunt test.
So if I look at a brochure,
Or a booth at CSM or anywhere or
a website at APTA Massachusetts.
I should be able to answer three questions
without thinking.
Right.
And they call it the grunt test.
What do you do?
How does that make my life better or
not?
And then if I like the answer to
number one and number two,
what do I have to do?
Right.
Right, book now, join here,
da da da da.
And it needs to be,
a lot of times, in healthcare,
I'll just take shots at ourselves, PT,
we over-explain and we over-complicate
things because, I don't know,
maybe we feel like we have to.
And I'm just here to tell you that
the New York Times is written at an
eighth grade level, on purpose.
Not because they think ninth graders don't
read,
or adults don't read at a higher grade
level,
they understand that you can't be an
expert at all of these different things.
So keep it simple.
We know healthcare literature is even at a
lower level than that.
So to keep engaging and working in such
a diverse population,
it's got to be really simplistic,
really to the point,
but make a good point.
But there's a couple of times that I
wanted to,
my dad has a PT and OT and
an SLP and they'll call me for updates
and they change every once in a while.
So a lot of them don't know that
I'm also a physical therapist, right?
On top of being the son.
Right.
And I want to very...
I don't know how it would be absorbed,
but I'm like,
that is over the average person.
Some of the things you're saying do not
need to be there.
Talk to me like a normal person.
I know you're a normal person.
I've met PTs.
We're normal people.
On the phone, stop being that.
I don't know what that was.
Don't do that again.
For clinicians who feel busy or
disconnected from advocacy,
where is that soft first step?
Where should they go?
They're like, okay,
I don't need to do something.
Fine, I'll do it.
How do I sign up?
I'm not in this club yet.
Where do I go?
Right.
And the first thing we've had people do
is actually email our association,
go to our page, email us.
But...
We would like this to be more forward
facing and put out something that people
can go to.
Be able to highlight that on social media
and be able to have an easy landing
page on our website that may or may
not be member protected.
If it's not member protected,
at least we're getting the advocacy word
out there for what we want.
And the more voices we have,
the more we'll achieve.
I mean,
we see what the nursing association does
in Massachusetts,
and they are a powerhouse.
They have so many voices.
When they're asked to show up for
something, they show.
So what can we take away from our
sort of cousin, you know,
nurse nursing profession?
What would they do?
Would they do well?
Or what should we look at from five,
ten, fifteen years ago?
What can we borrow?
Their messaging is really, really good.
So they're not just their membership,
but also, you know, it starts in school.
that's what we're getting into now is
we're starting to get that word in
schools,
being asked to guest lecture about
advocacy.
We're making it a focus for our annual
conferences now.
So we just had a great hour long
opener about advocacy at our annual
conference last November.
So we are we're taking steps to get
there.
And it's something that's just been we've
kind of missed, I think.
Yeah.
What's your big, big, hairy,
audacious goal as
president of Massachusetts.
What's something that when you're sort of
done and you pass off the office to
the next person that you're like, hey,
if we achieve this,
this is what I'm aiming for.
Yeah,
if we can get a third of our
registered PTs in the state to sign an
advocacy letter.
Ooh, okay.
You know,
for each thing that we're putting out
there and like this is important because
of this.
And if we get those voices consistently,
that is a huge, huge win.
Yeah.
And that's that's engagement.
That's people caring.
That's people taking ownership of their
profession.
And that's really what we're looking for.
Where are you now?
Ballpark.
I would have to go through because we're
on a different app now.
And so now that we've just kind of
signed on to a new application,
we're going to be able to track that
much easier.
So I would love to tell you the
number, but I don't have it.
What gets measured gets improved.
You can't measure it.
You can't possibly improve it or know it's
being improved.
Absolutely.
What gives you hope?
Let's go bigger.
We'll go bigger than just Massachusetts.
What gives you hope about where the
profession's headed in general?
I think when we get together as leaders
that we're all on the same page.
I think the leadership of APTA itself has
kind of changed their mentality too.
New strategic framework really shows that
payment by fourteenfold is the most
important topic.
It was not small.
Right.
It's payment and then fourteen miles of
nothing then number two.
Right.
And so I think that that focus,
especially even just in the last really
nine months,
that that focus has changed and how
they've changed their education,
their programming and where we're at in
terms of leaders being able to talk about
things.
That's really important.
Yeah.
And, you know,
getting on the same boat really makes us
want to, you know,
we're all rowing in the same direction,
even if we have to do it different
ways.
Correct.
Yes.
I never knew the differences from state to
state.
I just assumed...
population.
I don't know.
And then I looked into how different state
practice acts are.
And we are fifty different little
countries that are tied together.
Yes.
And every state legislature works
differently.
You know, we see how a win gets,
you know,
how does a win go in Utah be
different than how it's done in Montana,
than Colorado, than Massachusetts.
And so knowing how the legislature works
is really,
really important to
to get wins with our mechanisms.
And if you don't,
you will get steamrolled or you will get
something just,
you'll get completely rubbed,
something completely taken away from you.
Colorado had a thing up in, uh,
in their state legislator about losing
term title protection.
Like they were going to lose this.
Right.
And they were like, we have,
once we get our,
our members to rally and say,
we might lose this.
Right.
Everybody will pay attention the day after
you lose it.
Right.
Where are you paying attention?
What are you doing six months before we
lost it, bro?
Like you're a day late, a dollar short.
Yeah.
Right.
You don't want that.
No,
we want to have those voices be ready
and willing to do things.
And then also, if you get ownership,
you get hospitals,
you get rehab directors bought into what
we're trying to do,
they're going to ask their staff to do
it.
Yeah.
So you're just going to kind of work
through a network of amplifiers that if
the messaging is good and it's something
that is worthy for the profession,
people will do it.
Love it.
We have a tradition on the show.
Every episode,
we do something called the parting shot.
This is the Parting Shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
All right.
Parting Shot is brought to you by Sarah
Health.
Find them online at SarahHealth.com.
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Spoiler alert.
Yes, you can.
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It's S-A-R-A-Health.com.
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All right.
Parting shot.
What do you want to leave with the
audience today as we wrap up?
It's something I have written at the
bottom of my notes for every board of
director meeting that I run now.
It's never assume and always ask.
Ooh, never assume.
Yes.
Always ask.
Appreciate your time today.
Thanks for doing the service.
I don't live in Massachusetts,
but if we get wins in Massachusetts,
it might be easier to get wins in
my state of New York and your state
of whatever.
So thanks for doing what you do as
well as the rest of your board.
Of course.
Thank you so much.