Thanks, Voice Guy.
I want to say thanks to Sarah Health,
the remote care platform helping clinics
boost revenue without adding staff.
They're supporting the show.
Sarah automates daily patient check-ins
via text.
Read into that via text,
which means no app and no logins.
You had me at hello.
No app to download and no login?
A password to memorize?
Great.
They lead to better outcomes.
Check them out.
It's a simple way to meet those RTM
requirements, improve follow through,
and actually get reimbursed for care
between visits.
It's simple to set up,
which I know you're probably thinking,
how hard is it?
It's simple to set up, simple to use,
and patients actually like it.
Why?
Because they don't have to log in
anything.
It meets them where they are.
Where are we?
We're in our text message inbox.
That's where we are.
SarahHealth.com.
That's S-A-R-A Health.com.
I would say Sarah without the H,
but then, damn it,
there's an H in health.
So it's Sarah, S-A-R-A Health.com.
Our guest today started in the clinic.
Like most of us, patients on the schedule,
a lot of them.
Documentation to finish, a lot of it.
Productivity targets looming, always.
But instead of just treating patients,
he kept asking bigger questions,
which usually leads to stuff like answers
or pathways.
Why do some clinics scale and others
stall?
What are the reasons?
Why do some PTs plateau financially while
others build influence and leverage?
What's the secret sauce or is there one?
what is the future of musculoskeletal care
actually look like and who's controlling
it over twenty five years he moved from
provider to operator from operator to
executive left and came back and now
advises growth across healthcare
organizations navigating predictive
analytics value-based care the big hairy
scary future and all of it what it
really takes to win
in modern PT.
Today,
we're talking about career progression,
economics, value-based care,
and why PT's role in MSK is foundational
to this healthcare system.
Let's welcome to the show,
Jeremy Vandivender.
Jeremy, welcome to the show.
Thank you.
How was that intro?
Did I overhype?
Did I miss anything?
I think you're good.
Yeah.
So you've done a lot of different things
and you've seen things from different
angles.
I think that's even probably more
important too,
because you can talk to people at
different points in their career,
different spots in this profession,
and you've even sat in that chair or
you've worked with people who are sitting
in that chair.
So let's start with a huge open-ended
question.
When a PT says,
I want to be successful,
what do they usually mean from your point
of view?
And what are they missing to get there?
Yeah, unfortunately in our profession,
I think the pathway to success is pretty
pretty confusing.
I mean, in other professions, you know,
you think about LSUs being an attorney,
for example.
You go into corporate law, you know,
it's a very linear pathway.
You go in, you're a first year,
second year,
you go down the process and either,
you know,
you're going to make partner or you're
going to peel off and do something else.
And it's clear.
Banking, you know, all those lines.
There's a
Very direct pathway that people are
brought into.
I mean, even with physician practice,
I mean, they go through the residency,
they go through their internship,
their fellowship,
and then it's on a practice.
In our world,
and I navigated this very early on in
my career of what success would look like.
know originally i wanted to be a professor
a biomechanist a researcher and a super
elite physical therapist and to me that
was success i i was going to be
the next you know using an iconic name
kevin wilk from you know twenty five
thirty years ago that was what i wanted
to be like
then i got into the mix of that
and i wasn't great at research i went
to get a phd and i just i
could think about it in my head it
was amazing but i just it wasn't what
i executed on so i had to find
another pathway and for me that was a
much more of a i'd say an executive
trajectory pathway i i go back to like
what physical therapists you know see in
their career i don't think that they
come out of PT school or in the
early, you know, literally that five year,
first five years of their career where
that's in so many ways the inflection
point of where you're going to go.
There's such an unclear pathway towards
what
Determine success,
so I think that physical therapists look
at it as a scatter plot.
I'm going to be.
You know,
there's something that's going to be a
great therapist and take care of a bunch
of patients and get a do a residency
and be a star.
There's others that they want to go into
more of a.
administrative route.
And what I found in a lot of
those cases, it's not okay, the steps,
they can say,
I want to go this direction,
this direction, and maybe figure that out.
But the outcome is really unclear.
And I think there's a bit of a
maybe it's a glass ceiling,
maybe much more than a bit of a
glass ceiling.
come up through the ranks as being
providers and are going this direction of
let's call it executive leadership as an
example,
they don't see themselves often beyond the
role of VP.
They see themselves kind of landing in
this static state at, you know, ten,
fifteen years out and it's okay, now what?
where I come back to and PTs I've
talked to,
I don't think they really know what
success actually is.
I think that's lent itself to a little
bit of maybe a regression around, well,
if I can't
see myself on a pathway to economic or
professional success that's really clear
and really jumps out and I can define,
then I'm just going to acquiesce to more
of a lifestyle career.
I'm going to focus on having a good
income, doing something I like,
and having work-life balance because I
just don't think they see the opportunity
for a real destination,
what you consider financial, professional,
high level success at the top of the
industry so I think it's a honestly it's
you know I'm answering your question with
a bit of a um a gap here
which is I don't think most PTs honestly
know and they all to uh in some
sense is the easiest pathway which is be
good I'll be a good clinician I'm going
to have a nice lifestyle and you know
that's fine yeah
Yeah.
Somebody else,
I can't remember who answered this said,
part of it might be the educational
environment, which is after eighth grade,
I go to ninth grade.
After ninth grade, I go to tenth grade.
There's always something set up for me.
And then you graduate and it's sort of
like, well, do whatever you want.
But you're saying,
what are those pathways?
And you would think in a world with...
smartphones where we can essentially peer
into corners of the world that we would
not be able to see.
Twenty years ago,
every day someone could be showing you're
getting ready with me, you know,
behind the scenes as an executive,
behind the scenes as an owner.
People still I guess they choose the path
of least resistance.
That's close.
Like someone said the other day,
you don't choose the best tax preparer or
mechanic.
You choose the best one that you know.
So if you don't know the pathways,
if they're not obvious to you,
It's a self-imposed glass ceiling almost.
Yeah.
And that's where I reflect back on my
early career.
And I felt that in many ways early
on, too, where, okay,
what am I going to do?
And I didn't really know what I was
good at until I had the chance to
fail or succeed on my own.
You never do.
Yeah.
I had my first,
I got my first director job, uh,
running one clinic in the two thousand
one.
Um,
I was two years out of PT school.
I had no idea what to do.
I, I had no business training.
I had no leadership training.
I just said nothing.
I, I was at health South.
Uh, the clinic was falling over.
Um, there was really,
I think we're seeing like eight visits a
day.
it's the kind of clinic you give to
a first-time director or you it's you know
it fails it fails it doesn't really matter
so they give it to you know someone
two years from out of school and i
was able to turn that clinic around from
doing thirty five forty visits a week to
a hundred eighty visits a week within nine
months and it was literally just me
throwing on you know my my backpack and
my business cards and walking the streets
of hoboken to talk to all the doctors
do all the community work,
do everything you needed to do to build
the practice.
And then I realized, you know,
through doing that,
that that's actually something I'm really
good at.
I'm really good at, you know,
visualizing what success and visualizing
what good or great looks like and sharing
that story and then developing
followership.
And it equated to getting a really strong
following of referrals early on.
And I realized, oh,
In some sense,
I was successful because I was the loudest
voice in town.
I was the one who was willing to
get out there and walk around and knock
on doors and tell the story.
I certainly wasn't the best therapist.
I was two years out of school and
didn't really know what I was doing,
but I worked really, really hard.
And then I realized that this was
something that is a unique opportunity for
me to build upon.
And that's where I went full on to
be on the business side of physical
therapy.
But I would have never, ever known.
I would have never even known this had
I not gotten that opportunity to lead a
failing clinic.
And that's what actually brought me to Ivy
a year and a half later to start
that company.
But the real thing that I come back
to at that point in time
I reflect on that, you know,
self-imposed glass ceiling.
I was just never comfortable being held
back.
I was like,
I'm going to find my way.
So I spent a great deal of my
time finding really smart people and
incredibly talented people that I could
force myself to be mentored by.
no one wanted to mentor me i forced
myself in the room every turn and i
eventually found my footing uh reminds me
of a you know then this was you
know not getting paid for this is
something i talk a lot about you know
i did a lot of things early on
that i did not get paid for i
was making very low my starting salary was
less than forty thousand dollars a year i
was a clinic director treating ninety
visits a week making forty eight thousand
dollars a year
those were difficult times and you know i
was in new york um and i was
going to the upper east side of manhattan
to the hospital for special surgery and
watching surgeries on my own outside of
hours you know six in the morning uh
getting up there and you know watching
four hours of surgery then going to
hoboken and treating for ten hours and
going it was a that's what i had
to do and i remember um one of
these stories really sticks with me and
there's this uh
iconic doctor who was the chair emeritus
of the Hospital for Special Surgery,
former team doctor for the New York
Giants, and Russ Warren,
just one of the icons of orthopedic
surgery.
I remember I was in the locker room
going into surgery with him and David
Olchek and a bunch of other big-time
doctors there,
and I was this twenty-six-year-old PT who
didn't know anything up or down.
And I'm sitting there, you know,
putting on my scrubs and here's this Dr.
Moore next to me.
He's a big imposing guy.
He looks at me, he's like gruff,
you know, he's in his seventies,
just a gruff guy.
And he's like,
what are you doing in here?
And I'm like, you know, it's HSS,
the residents, the fellows,
these are ballers.
I mean, it's a whole different level.
And I'm just his PT.
And I just looked at him and I,
at this moment, I had this like,
sort of strength of, okay,
I'm just going to stand up and say
why I'm here.
And I said,
because I want to learn from you.
You're one of the best doctors in the
world.
I want to see you do surgery and
learn from you.
And he looked at me and I,
it's a big risk to say that,
I guess, because I,
and he looked down and he's like, oh,
okay, that's great.
Let's go.
Before I knew it, that guy, that doc,
a couple of things,
he introduced me to the New York Giants.
And I started having the opportunity to
work with the Giants and work with the
training staff of the Giants at the same
time, which is really cool.
And that's actually what led me into Ivy
because that group of investors,
that group out of original twenty five
years ago,
those are the ones that raised the capital
to start Ivy Rehab.
And they knew me and they literally knew
me.
because i forced myself in that room i
was a nobody and that's what gave me
my launch pad to start a practice and
ultimately it started a company and you
know twenty five years later here i am
there's a lot to unpack there man you
just covered a lot of ground
Um,
I want to go to one thing I
wrote down,
which is you said you could visualize
things in research,
but it wasn't working out.
So you recognize you had a skill and
you tried to use it one place and
it sort of wasn't working.
And then you use that sort of same
skill, a different place.
And next thing you know,
it worked really well.
And the important part,
you liked it because even if it worked
and you didn't like it,
you probably wouldn't have done it as
much.
And that goes to-
And something cool about that, I mean,
you say it and it's not always as
linear as like I applied it.
It didn't work.
I went somewhere else.
I mean, this is way down the line.
One of the things I'm most proud of
or had some of the most fun doing
in my career was between twenty,
twenty two, twenty, twenty three at Ivy.
And we we got to a level of
some real scale and we were, you know,
built into a national engine people
started to know about us and we had
a you know a mandate around you know
in my view when you're at that level
as a provider group you have a mandate
to the profession to elevate the game and
do things the right way and we decided
that we were going to make a material
investment in building an outcomes and
research platform from the ground up
And, you know,
not most companies don't have it.
We didn't use a vendor.
We built it, you know, from the bolts.
And that was, you know,
made me have the opportunity.
Then I had to leave that initiative and
bring on a PhD and build the whole
thing and do our, you know,
it started with MIPS and became a true
outcomes program.
And what I realized is I love research.
I love data.
I love all that stuff.
I'm not a good writer.
I'm not a good publisher.
I'm not good at seeing a study through.
I always make a mistake.
do it but what i'm good at is
articulating the vision seeing it and
working around really smart people who
have a skill set and expertise there and
you know look back that was one of
the things that i'm really most proud of
was creating this um really high-powered
uh best-in-class outcomes um predictive
analytics platform that we could do
research out of and you can see you
know people at ivy publishing research out
of this platform and it's uh my name's
not on it but it gives me a
lot of joy to look back on and
say
that's something i was good at yeah you
use your familiar skills in an unfamiliar
way you thought well i like sort of
what research does i like the impact it
has so i'll be a researcher and then
you got there and you're like oh i'm
not great at this but i still like
the way it works but if i can
fund the engine that can produce research
that's just as important right i work with
the foundation for pt research it doesn't
make any sense to have jimmy mckay on
your board
Because I haven't done a lick of research.
But they don't need another researcher.
They got oodles of that.
They need people who understand how to
create attention.
Because attention drives marketing.
Marketing drives business.
Business drives money.
Money drives research.
And then round and round we go.
How did you get people to follow you?
There's a lot in that first clinic, right?
How great... Well, I mean, looking back,
it's like you got handed something that if
it failed,
nobody would have blinked twice.
But you looked at it as...
I can do whatever I want and I
can poke and fail and poke and...
Hold on a second.
I pressed this and that happened.
How did...
You mentioned how you got external buy-in.
You put a backpack on.
You filled it with business cards.
You didn't come home until the business
cards were empty.
You got up at...
I don't know what hour you were getting
up to get to HSS.
It's six o'clock in the morning.
But in New York,
you must have been getting up at four.
Yeah.
How did you get internal buy-in?
Because there's no way you did that on
your own too.
No.
You know, they...
some reason i've always had um a gift
um i've been blessed with the ability to
uh build followership i've been told from
people that will say hey i want to
jump on that train i've seen it a
bunch of times in my career and i
think what it is is um i lead
with passion i i i'm not i
I found that negativity is very obviously
very polarizing and being your choice
every day to be positive or negative and
how you look at the world and the
outlook.
And sometimes it's really hard.
Sometimes you wake up and you're
surrounded by negativity.
What I do know is that people don't
follow or get inspired by negativity.
They will act against it.
They'll engage in negativity,
but they're never going to follow that.
So I've found myself in my most powerful
capabilities and where I've been at my
best is when I have a kind of
a broad
just a light about the future,
which is if we come together and leverage
our respective skill sets,
and I'm going to give you,
and this is anybody who would work with
me,
license to do what you're passionate
about,
and I'm going to help you find the
way.
I look at myself as a leader along
those lines of I'm here to inspire and
bring out the best of someone and to
give them the road to go and do
it.
So from very early on,
when I was running a clinic to where
I am today,
I've always given people around me who had
the willingness to jump on a train with
me the autonomy and the ability to do
what they're best at and to support them
in doing it.
And it really has created a tremendous
amount of followership that I'm really
proud of.
And that I empower,
I try to empower people to be their
best and do what they have fun and
enjoy doing and run with that.
You're a Hannibal from the eighties,
a team.
I do a lot of eighties TV reference.
You're, you're a Hannibal, right?
Which is, you know,
I'm holding a cell phone right now and
people will give credit or points to
people who have large followings.
But what are you actually creating?
Here's the question.
You have a lot of followers.
Where are you leading them?
What are you leading them to?
If it's to collect followers,
I don't understand the value in that.
If it's to empower people to do the
most them,
people will follow you for a long time.
They will follow.
People will react to negativity.
Positivity is slower.
but more, but more powerful.
It's just also harder to cook with,
you know what I mean?
Like it's.
Yeah, it is.
And I find that to be, you know,
honestly,
one of the hardest things I do every
day is, you know, you wake up,
start your day and you have a choice,
you know,
how are you going to see the world
and, you know, look at the news,
look at anything else,
look at your emails.
And it's very easy.
to get pulled down into you know what
was me or you know what was the
profession um you know we're getting
clobbered by raids and turnover etc and i
just for whatever reason throughout the
course of my life and this certainly
predates myself professionally have just
always chosen to say i'm going to take
the more um
uh aspirational road because that inspires
me personally and if i'm inspired
personally i can then inspire other people
and i really think that inspiration is
about and followership is about giving
people the tools to do what they're best
at and then giving them the free reign
the license to go after that without being
afraid of failure without being afraid of
you know letting somebody down um and
supporting them through that failure uh
that i mean i i
I'm just astounded by, you know,
looking back on some of the people I've
been able to work with and see what
their careers have done.
And that's really a cool and very,
a huge variety of success for people.
I mean, I've got, you know,
colleagues that I thought were going to
be, you know,
clinical executives because they were so
good at a certain party.
You know what,
that's not what they wanted.
They wound up, you know,
circumventing back to another place and
becoming rockstar physical therapists,
treating, you know, elite athletes and,
have an amazing career there it's not
defined by how much money you make it's
defined on how i think that's going back
almost the first question like what like
what really um matters the most it's
allowing people to do what they love find
what they love and do what they love
and if you let people do what they
love and build around that they're almost
always going to be successful
Yeah, they'll find a way to success.
Like a lot of times you look at
someone who is successful, I have anyway.
And I've seen like it sort of doesn't
matter.
But it was like if they really cared
about it,
they'd find a way of being the best
florist in town if they really just
decided one day it was flowers and not
rehab.
So you've been doing this for a couple
of years.
Yeah.
I like similarities and differences.
Yeah.
What are the things that have stayed the
same?
And what are the things that have changed?
Macro things in the profession.
Yeah, so, um, foundationally,
I kind of laugh when I think about
this, like,
what does not change that the human body,
the patient, you know,
it's that the end user is the same.
Um, there's no difference in, you know,
what people wanted from PT,
thirty years ago, fifteen years ago.
Uh, they want to feel better and, um,
you know, they are there.
trusting the therapist to take care of
them, make them feel better, educate them,
support them.
I think that's the foundational thing that
has not changed.
Everything else, honestly, has changed.
You think about it from,
I mentioned this before,
I came out of PT school,
there were
two hundred applicants for the first job I
got in Kokomo, Indiana.
I don't know how I got it.
My starting salary was thirty seven five.
I had twenty patients a day on my
schedule.
There's no question I get to complain
because there were two hundred other
people waiting for my job.
This is in a rural area an hour
north of Indianapolis that
nobody would want to go to, but yet,
two hundred people wanted that job.
And, you know,
that environment is obviously completely
different.
And I don't go back to the glory
days where, you know,
we should be treating twenty visits per
day.
You know, I don't celebrate that per se.
I do think that that's a whole other
conversation about productivity and what
can be done and expected and the balance
between quality and productivity.
Obviously, that's certainly changed.
There's no question that requirements
around documentation, authorization,
uh etc have become exceedingly more
difficult but on the other end of that
the technology and tools to support that
have become our next generation i mean
when i came out of pt school i
was writing notes on paper um and we
did have authorization you know and
verification and i was we had to you
know support our visits people don't think
that um they think that'll happen in the
mid to two thousand that's not the case
it was i remember ortho net coming in
in the early two thousands and
making our lives miserable and saying,
if you don't have, you know,
if you have four out of ten pain,
you're discharged.
If you have seven out of ten pain,
you haven't gotten better.
And that was, you know,
twenty two years ago.
So I don't think those things have changed
per se,
but definitely the demand for validating
treatment have changed.
You know,
the reimbursement climate is different,
obviously.
And in some senses, you know,
you can see that it's
We have not seen reimbursement keep up
with inflation,
but reimbursement at the same time is
significantly higher than when I started
practicing.
And there's a number of reasons for that
as well.
And I think people get lost in that
myth that physical therapy reimbursement
is in the basements.
It's not.
But you got to work for it.
I mean, there's an equation here.
You just don't fall out of bed and
get a hundred dollars a visit.
You've got to work for it.
I definitely think the physical therapists
are obviously very different.
I mean, when I graduated,
I was the last bachelor's class of my
program before they swapped to a DPT.
And the mindset of a therapist,
who we were all those years ago,
I think is definitely different.
There's a bunch of feeders to that.
It was massively competitive in PT school
in the nineties and eighties.
It was almost,
it was harder than medical school,
four or five hundred students applying for
forty spots.
So I think we had a lot more.
Thirty years ago,
therapists were very intentional about
going into PT school.
And it was a decision you made.
It was really hard to do,
really hard to get in.
And I think most of the therapists back
in that generation, myself included,
because it was something we were so
dedicated to becoming and we stuck with
it.
And I see a lot more people today
saying it's hard or do something else.
I didn't see that in my generation.
And then one of the last things I
would call on just from a personal
standpoint is work-life balance was never
part of the equation.
We didn't think about that.
Words didn't exist.
We worked and the rest of it kind
of came.
And I'm not saying that's a bad thing.
It's great that we have a better,
broader view of life than just grinding
work.
But it has definitely had its impact on
the professional advancement opportunities
in our profession around this work-life
balance construct that I've never embraced
personally,
but I definitely see the value of.
Well, you work with organizations,
and we'll get to what you get to
do now in a second.
But I feel like, well,
I'll tip my hand a little bit,
which is since you've done most of the
roles at organizations you're probably
advising, right?
if a clinician is sitting there saying,
what do we want?
More money.
When do we want it now?
Are the people who find most success on
the leadership angle saying, that's great,
let's figure out how to do it together,
instead of saying, well,
these kids today just want to work less
and make more.
Are the people most successful the ones
that are saying, like what you did,
let's figure out how to do that together,
because if you get that,
you're never going to leave me,
and then I'll be able to hand you
a clinic in two years, right?
where it feels like i understand everybody
nobody's wrong and what they want where i
think there's a disconnect in is how do
we get that it's not me not paying
you or making you work too much and
me laughing and swimming around scrooge
mcduck style in my vault that's probably
not the case it's not the case how
do we get there together i feel like
the organizations that figure that out
Yeah, there's no question.
You have a choice when you're presented
with major market shifts over a generation
and you see this going.
I recall experiencing this really the
strongest in
Um, when the great resignation came,
it's like, all of a sudden,
in April of twenty, twenty two,
everyone decided that their pent up desire
to leave a job would happen in the
same day.
Right?
Turnover went from normal to just boom,
like the world.
And I, this was an experience I had,
um, I'm really proud of that.
We,
as a management team did it when that
happened.
Um, we.
looked around and we didn't blame the
field we didn't blame the universe around
us we blamed ourselves and said wait a
second we're missing something what are we
going to learn from this experience and we
immediately you know dug into the ground
we polled our people we asked the hard
questions we made ourselves vulnerable uh
we let them beat us up around what
it was that was driving to you know
this significant shift in turnover there's
obviously a lot of pent-up frustration and
fatigue coming out of covid it was just
a resettling of
you know the way the world was operating
at that point but we learned a ton
and you know what we learned is for
us to be successful and to engage our
therapists we had to meet them where they
were and that's providing them the tools
and the experiences that matter to them
clinical education
professional support and development,
alternative pathways to what success
actually means,
a clinical career ladder that allows you
to celebrate and thrive clinically,
if that's your direction.
I think there's far too little of that
in the profession where we're
incentivizing and celebrating great
clinical work.
on the alternative,
and we built a very powerful executive
leadership trajectory to say,
if you want to go this route,
we got you.
And we built internal training that we
invested in as a management team to help
them get to that level.
And we pulled back all the layers of
the onion that you need to truly
understand the profession.
And we shared that with our teams.
And I think the
you know you want to understand how to
make more money here's the equation
therapist generates x they want to make y
we need to make a margin to preserve
the value of this business and more
importantly because that the value of the
business doesn't resonate to people what
they care about is you know what is
it what are you investing back and we
were very clear that all of the money
that we made generally speaking was
invested in the platform and in the
development of our teams and we build you
know nine residency programs
to bring up our clinicians.
And I, a hundred percent, as you said,
that the provider groups that are doing
that and not sitting back and, you know,
angrily arguing with the windmills or,
you know, swinging, you know,
I'm sure there's some other narratives out
there that use, but, you know,
fight with windmills that you're not going
to win that fight.
You know, you,
the world is telling you something,
you've got to respond,
react and evolve and the great companies.
And there's several of them out there are
doing exactly that.
And they don't have to be at scale.
This is not an element of, okay,
there's the, you know,
the five or six large companies that are
out there that are able to do this
and the rest of the universe can't.
That's just not true.
The in-between, the clinics that have,
you know, two, three, four,
the companies that have two, three,
four clinics, fifteen, twenty, a hundred,
they can do great things too.
And many of them are.
It's just about meeting your team and your
clinicians and not just your clinicians,
your whole team where they need to be
met.
and not arguing with the past and
complaining about the future,
but being solutions-oriented.
Sounds like Chris Voss,
who was the FBI hostage negotiator,
would say,
if someone's speaking logically and you're
speaking emotionally,
you're just going to talk past each other.
But when you can recognize that as a
real leader...
you understand if someone's speaking
emotionally, my job is to listen.
It sounds like the really fancy thing that
you did there, Jeremy, was listened.
And then you evaluated what was said,
figure out what you could do about it.
And then you did that.
Probably not all of it at once because
that might not be possible,
but you kept listening and you kept
evolving.
And when people feel, Oprah said this,
people want to be seen, heard,
and understood.
If you can show them that,
not just tell them that,
you can show them that,
People tend to not want to leave.
And it's something I love about
consulting.
That's actually the first thing I do with
any organization that I go into and look
at as a consultant is,
what is the state of the org?
When you're hired as a consultant,
a lot of times you're viewed as,
come in here and fix it.
Get things better tomorrow.
I've got a problem.
I need you to be a solution.
Sometimes I feel like we're like the
Winston Wolf of from Pulp Fiction.
That's my generation.
When you come in,
I'll leave the movie to the rest of
the audience to obviously watch.
I'm amazed by how many people have not
seen Pulp Fiction,
but I
Look what you just did.
Winston Wolf,
and if you haven't seen Pulp Fiction,
turn this episode off right now.
I don't want to speak to you.
It's a great film.
They were in an emotional state.
Something bad just happened,
and they were emotional.
And he walked in and was just like,
I am speaking logically.
I am Winston.
I am in charge.
You do what I say.
You will get this.
And they did everything he said,
and it happened.
But he had to put them on the
logic train.
He's like,
I'm not going to speak to you emotionally
because then we're just going to spiral
around in circuits.
Then we all get caught.
I'm going to bring you into logic mode
now.
And I'm going to tell you one thing
to do at a time.
Do that.
We will get that thing I just promised
you.
So, you know, leadership,
leadership lessons from Quentin Tarantino,
you know,
it's a bit of a cabaret film, but,
you know, it does,
it definitely resonates from, you know,
where I,
and what I first do when I go
into an org is, you know,
it's let's talk about leadership.
your team, your culture,
what are you doing?
What are your pain points?
And now, obviously, you know,
that when you're a consultant,
the biggest pain points are always,
I want to grow my revenue or I
want to build my team.
You know, I've got a turnover problem.
I've got a marketing problem.
I've got a sales problem.
It's easy just to go right to the
problem.
I want to get underneath that and truly
understand why is that happening and what
do you want to do about it?
We listen, we probe,
and I encourage something we did.
I mentioned Ivy.
It was such a great experience.
We did pulse surveys of our team
quarterly.
It's one thing to do a pulse survey.
If you haven't seen the pulse survey,
it's a really great tool.
Twelve questions from
I can't remember the book.
It'll probably strike me in a bit and
we'll figure that out.
But it's a great way to learn about
the experience of your team,
but it's only as good as what you
actually do with it.
So I've always said this,
you don't do a poll survey or a
survey like that to just hear the answers.
You do it and then you wrap it
back and really drill into where we're
going and have conversations with your
team to say,
I recognize
this and I'm going to fix it with
you for you to give you a better
experience.
And when you do that kind of goes
back to your saying about Oprah people,
that's what leads to people trusting you.
And of course you have to execute.
And that's the big role of being a
consultant.
That's what I really love to do is
to get in there, to dig in,
to explore.
I think it's also why I love doing
M&A because
because you're going in and you're
learning,
you're peeling back layers and you're
finding the different pearls and then,
you know,
building a plan around those pearls.
And it just is something that I would
encourage, you know, every company owner,
anybody that's got, you know,
wants to reach this generation,
grow their business, be successful.
You've got to go back to your team
and understand what their motivations,
what their experiences are and build off
of those.
Otherwise you're completely blind.
I learned a leadership lesson from my dad
who was not in business.
He was a New York City firefighter.
When he got promoted from a firefighter to
a lieutenant, he was like,
now I'm in charge of other people.
The leadership lessons that he got was,
I work for them.
I wear a white shirt now.
I'm in charge,
but my job is to bring everybody home.
So my job is I work for them.
And I when I took over my,
you know,
I took over a radio station at like
twenty four.
And I remember like being so nervous.
I had worked under the guy who ran
the radio.
I was not starting a radio station.
I was just like essentially it was like
I was handed a thing was like a
B plus.
It was like, just don't lose.
If you stay B plus, you're fine.
But I was sleeping on the couch.
I was so nervous.
Like I wouldn't go to bed.
I was just staying up.
And my dad was like,
there were two things he gave me.
One,
is anybody going to die tomorrow if you
screw up at the radio station?
And I was like, okay, dad, no.
Got it.
And then once he got me giggling,
I left emotion, went back to logic.
And he was like,
do your jobs just to listen to them
and then give them what they need.
And I was like,
oh,
the answer's already gonna be in the room
if I shut up.
My job was not to go in there
and be like, I have all the answers,
follow me.
My job was like, what's your,
give me your biggest problem.
Give me your biggest three.
And then which one can I solve?
And then you trust me a little more.
And I go,
now when I tell you I'm working on
the other two,
stick around and we'll do that.
And that was it.
I did that over and over again.
You know, as you talk about that,
I reflect on just some of the lessons
I've had in leadership and that you speak
to the, you know,
we complicate things very often.
And I like the point you said,
is anyone going to die if this radio
station fails?
Is anyone going to die if the clinic
I am in fails?
Hoboken twenty five years ago doesn't make
it now.
And, you know,
I you mentioned your father in law or
your father is a New York City
firefighter.
My father in law, my wife's mother,
he was a New York City cop for
forty years.
And he was ultimately one of the you
know, he was very high up.
He was the
I think one of the top NYPD officers
on the ground at the World Trade Center
after the attack.
And my brother was an infantry combat
officer in Iraq and Afghanistan and went
to West Point and was in the hundred
first airborne in Iraq and then later in
Afghanistan.
and you know what i i think in
that early stage of my career that in
two thousand one two three four when i
started to see like i was going in
somewhere some leadership opportunities
and i was contrasting and i think it
really strikes me like it's not that big
of a deal my daughter would be like
it's not that deep you know it's like
this daughter's seventeen i hear that all
the time and i'll say that like it's
not that deep bro um it's like the
language of a seventeen-year-old girl um
but you know i wasn't saving lives i
wasn't in danger this was
you know I'm empowering people to to do
well in their career the stakes are
relatively low have fun you know um enjoy
it a little bit because there are
professions like you know your father is
my father-in-law my brother that are
inherently profoundly dangerous and the
stakes are significantly higher and you
can't really have fun in that situation
but you can enjoy that you know and
this is not that deep you know you're
helping people
get to you're helping to inspire and
enable and create opportunities for
people.
It should be fun and it should be
wildly rewarding.
So I think that's a really important
lesson for people as they explore their
career, their pathway.
Have fun.
Do what you kind of goes back to
what you mentioned before.
I'm kind of looping back to the original
question.
Like, what is success?
Like,
it really should be doing what you love.
Yes, that should be it.
Like the definition of success.
It can't be money.
it can't be prowess or power that's all
totally fungible that can be taken away
tomorrow it doesn't mean anything
everyone's got their own individual needs
and that's and i don't begrudge anybody's
you know going after the needs but at
the end of the day it has to
come back to you you're having fun and
beyond that you're inspired and you're
passionate i think success truly is
defined by doing something you love and
are inspired to do and you want to
get up every day and do and you
get the beautiful thing in a career is
you can recycle that
You know,
I once loved doing that as a clinician.
I love treating patients.
Then I loved being a senior executive
operator.
Then I loved being a development leader.
And now I love having a consulting
company.
It's hard, but that takes me back.
Like,
that's what gets me through the hard is
that I actually love it.
And I love the people I'm around.
So I use that word a lot.
And I think that's one of the most
critical things is you're inspired by and
you love.
And if you have that,
you can do anything.
Are you familiar with the ICA guy?
No.
Once somebody explained this,
you just explained it.
You don't know it,
but the Japanese put words to it.
And I don't like, you know,
and for the people listening,
I don't really do slides a lot,
but I keep this sort of one finger
away.
And that's the Aika guy.
So like you need four things.
You need to love it.
You need to be good at it.
You need to be able to get paid
for it.
That doesn't mean a million dollars,
but like you have to be able to
where that's like worth like balance it's
like yes yes you need to be able
to define what above water means to you
and then be above it or more and
then the world's got to need it and
this is one of those examples and if
you read a book about it they'll go
into like well three out of four is
bad but what it feels like you're saying
is like you can find that the intersection
of those four that's what aikigai is
reason for being that's the japanese word
You can find that in different ways.
I ran a radio station.
That was it.
The only reason I left there was the
world was changing with smartphones.
And I was like,
I'm not going to be able to do
that here.
I better go find it somewhere else.
I changed it.
Well, wouldn't you know it?
I accidentally bought a microphone as a PT
and figured that out.
But...
it can be different things and it should
change.
It sounds like, I mean,
you found the middle of that equation
several times with different roles.
Success isn't a job.
It's a combination of those four things.
And I think that's the beauty of,
you know,
if you think about this and explore this,
if I was talking to a twenty five
year old therapist,
come out of school and say, you know,
be willing to sacrifice and don't expect
the world to give it to you have
to be willing to sacrifice.
And not everything is about getting paid.
A lot of the best experiences I had
in my life where I was not paid
for them, I learned.
and you are trading the currency that you
gain is information learning and
development now i sacrificed a lot too and
you know in my twenties when everyone was
having fun and traveling and doing some of
the cool stuff i wasn't i was working
and you know i was grinding and trying
to build a career and you know i
that that was a trade-off i made uh
i don't regret it whatsoever i'd rather
you know do that on the back end
when i'm
you know i feel more comfortable and you
know doing what i want to do but
that was a deliberate sacrifice and a lot
of it was i did things that did
not pay me i went to training camp
with the new york giants and stayed in
the dorms for a week it sounds exciting
but it really wasn't doing sixteen hour
days i didn't get paid for that you
know i did not get paid to go
to hss i went to ten plus con
ed courses per year for five years i
didn't get paid for that i was making
an investment in myself
So I think I really,
I would always encourage, you know,
anybody who wants to be successful to make
an investment in themselves and see it
through and be willing to compromise a
little bit for the long game.
That to me is another huge part of
success is being willing to sacrifice and
go for the long game.
Yeah.
Well,
I think it sounds like you would –
if you were to give it – so
I had this question written down.
If you were going to give advice to
a twenty-six-year-old who just graduated
from PT school,
it sounds like you started answering that.
But it doesn't need to be the Giants.
It's the Giants if you want it to
be the Giants.
But whatever your version of that is,
quadruple down on that.
It could be a youth soccer club,
could be a hockey club,
could be a assisted living center.
You love working with seniors.
You have a connection with older people
and you want to help them.
That's what you should do.
It doesn't have to be glamorous.
It doesn't have to be sexy.
It doesn't have to be at the highest
level.
It's just got to be something you love
and you're interested
in doing you'll put your all to because
it's personally rewarding to you and it
doesn't even have to be in pt it
can be in any tangential area where you
can find that passion um i think burnout's
number one driver of burnout is not being
oriented around passion
it's not being oriented around something
it goes back to that illustration that you
gave before the solution to burnout to me
is to start talking very early on in
careers and plotting around let's stay on
track with what you truly love to do
and what you're inspired by and let's also
look at this in a it's not in
a vacuum and understand that's going to
evolve and being willing to allow that to
evolve and to work with people to help
to create pathways for them and on your
own to create your own pathways as that
does evolve and not be ashamed of the
evolution
i went into you know another space for
a little while i was excited you know
oral surgery space was excited to do it
i i left it because of culture it
wasn't a good fit for me and that's
what prompted my starting my consulting
firm you know it it's those experiences
are what allow you to go to the
next step so you know do them and
do them with inspiration and i think you
can have a great pathway
Agreed.
So talk just like a little bit about
who your firm helps.
Like what do you get to do now
and who do you get to do it
with?
Yeah.
So my firm's Equus Growth Advisors.
And the reason it's named Equus is that's
Latin for horse.
And one thing I share about myself,
my daughter,
that's the reason I'm in Florida.
My daughter is a competitive equestrian.
So I spend a great deal of my
time and life around horses and
And I thought as I started my company,
I'd name it as a tribute to my
kid because of the work she puts in.
I thought it was a cool just family
thing to do.
So I fashioned my work as a
strategy-oriented,
growth-focused strategic advisory firm.
across all of healthcare.
And my focus personally is on really
analyzing,
assessing businesses and creating
strategic solutions for them to navigate
the challenges they have.
Now,
largely the challenges that I get most
excited about
And I try to work towards our growth
oriented.
I've always viewed the world in our
physical therapy business,
all healthcare business as a revenue game.
And I think that's also part of that
kind of aspirational view or the positive
view that you can look two choices.
You can go to the middle of the
P&L or the top of the P&L.
I believe in going to the top of
the P&L.
That's fun.
This isn't fun.
I've never enjoyed managing the middle of
a P&L.
That means you have to cut costs and
that's never fun.
an enjoyable experience at least for me um
so i really focus on the top of
the p l of helping companies build a
strategic pathway to achieve their growth
goals i slot in a lot of times
as a fractional chief strategy officer
chief revenue officer and bring my
experience it's not just me it's really
important we share that equus has you know
fifteen
plus advisors and we've got a number of
clients.
It's not a PT oriented firm,
it's a healthcare firm.
We also have an M&A side of our
business where I merged in October with an
M&A advisory firm and they do buy and
sell side work
across all of healthcare so we can do
the M&A work for or with a company.
If targets you want to go after,
we do the buy side work.
If you want to sell your company,
we do the sell side work and everything
in between.
I try to build this as like a
wheel.
where we've got all the different elements
of impact across healthcare from patient
experience revenue cycle therapeutic
monitoring which is not again for just pt
it's across all of healthcare professional
development sales marketing talent
acquisition and i also work with a lot
of outside groups to help support needs
like data and health informatics will go
and build those systems for clients um so
it's a it's a broad but hyper focused
on strategic revenue growth and x
but not targeting goals.
So they get to hire your brain and
show you what they're either doing too
much of or not enough of so they
can continue to do the thing that most
people want to be doing.
Yeah,
and that's I think that's a really good
way to put it there.
They're hiring my brain,
my experience and the team around me that
collectively,
if you just think about us from a
musculoskeletal standpoint,
we've got two hundred and twenty five plus
years of experience around the table in
musculoskeletal care.
And it also points towards the things I
really am excited about,
which are longer horizon.
opportunities in musculoskeletal care
beyond traditional PT.
I love value-based care.
I love the evolution of hybrid-based
models and being nimble and thoughtful
about how to get to the patient.
I love supporting evolution and innovation
in healthcare.
I'm a big proponent of going to meet
the patient where they need to be met,
which is where they want to be met.
whether that's at home, in clinic,
virtually, any of those different areas.
And I'm such a true believer in PT
from the standpoint of bending the
musculoskeletal cost curve and the impact
it has on the overall expenses in
healthcare around the world.
I mean, we're talking
Forty,
fifty percent of healthcare spend is on
musculoskeletal.
Physical therapy is just so
disproportionately underrepresented in
that equation.
I mean,
ten percent of patients who need it access
it and eighty percent of them don't
complete a course of care.
I mean,
the opportunity is so profound that I
can't find any way to be negative about
what's in front of us in the PT
space because we sit at the,
literally sit at the dining table of this
massive opportunity to reduce cost of
care, improve access,
improve outcomes,
work across the entire healthcare
continuum,
threading through a number of different
areas that will impact patients and cost
and outcomes that I'm really bullish on
the future of PT.
I guess sometimes I'm a loud voice in
the room saying that,
but I don't think I ever won't be.
I think patients
love what we do,
we just need to get to more of
them.
And I think physical therapists are
amazing at taking care of patients,
but also they're amazing thinkers.
I think it's important that I share that
at Equus with my team,
so many of the people I work with
are PTs.
and i didn't hire them to be pt
consultants i hired them to be healthcare
consultants pts are amazing at breaking
down findings into you know thoughtful
algorithms and then planning care and then
going in and effectuating change it's no
different than what we do with a patient
it's just doing it with a business
equation and i found that physical
therapists are awesome at that so one of
the messages i would leave to pts is
understand and leverage that skill set.
There's so many applications beyond
treating patients that the way we think,
the codification of thinking through a
critical pathway of, okay,
patient presents to me like this,
I see this, I'm going to treat this,
that applies itself so well outside of
traditional patient care in consulting and
business operations and all these
different areas.
It's really...
an amazing skill set to leverage and i
think therapists really need to pull that
inward and say i've got us i've got
a skill set i've got a tool that
can be wielded so many different forms
it's it's a great skill set to tap
into all right well we have a tradition
on the show we always do something called
the parting shot this is the parting shot
one last mic drop moment no pressure just
your legacy on the line
I mean, you kind of just gave one.
You kind of just gave one.
I mean, you've given several,
but you can reiterate one.
You can reuse.
But what would your parting shot around
the topics we talked today be?
I'd say my parting shot,
my mic drop is embrace what you love.
Build your career around what inspires
you.
continually test that at all points of
your career don't look for people around
you to give you the solutions find them
within yourself and it starts with such a
simple equation what inspires me and when
you start to find like that you get
lost in that like i you know i'm
burnt it's just burnout is the equation
why burn burnout is
built off of you know lack of appreciation
lack of pull through there's all those
different toggling variables of burnout
but the center point to me around
navigating burnout and frustration and
challenges going right back to that place
of what do I love doing what inspires
me what do I define as success for
myself personally and not be pulled into
other people's definition of success don't
worry about what someone else says it's
exactly
who cares what I think about what success
is.
My pathway is not your pathway.
It's not someone else's pathway,
but we can all do incredible things if
we believe in them.
And the last parting shot I would give
is believe in the future of physical
therapy.
The narrative that's out there that,
you know, this is a,
you know, challenge space.
Yeah, there's challenges.
I mean, reimbursement goes down,
costs go up.
There's a, you know,
we're in an evolving state all the time,
but at the foundational core,
physical therapy is such a critical part
of the healthcare continuum.
And we lose track of that, that,
you know,
the opportunity in front of us to build
a profession and
that is highly valued by providers,
payers, you name them,
is right in our hands.
We just have to come together as an
industry, in my view,
and be positive and look at the outlet
of it's not, you know,
CMS isn't doing something, you know,
to punish us or, you know, we're not,
our reimbursement rates aren't going down
because we're devalued.
We've got to fight against that and
impress and show the value and never quit
because if you believe in something it's
worth the effort and I hope that everybody
who spends seven years and you know a
hundred thousand dollars plus to become a
PT believes in it otherwise why'd you do
it but tap into that belief um and
use that belief to carry us forward into
this next generation which I think is
I'm really excited about.
I think the future of PT is bright.
I think the future of musculoskeletal care
is massively important,
and we should be the centerpiece of that
as a profession, and I love it.
I can't wait to be a part of
it.
I'm ready to run through a brick wall
here, Jeremy.
You got me jacked up here at,
you know, eleven o'clock in the morning.
I like that.
I'll jump in the snow.
Let's go jump in the snow in upstate
New York.
I'll show you one of my palm trees
while you're jumping in the snow.
I'll put the link for Equus and for
you on LinkedIn as well in the show
notes.
But appreciate this, man.
And we'll have you back on the show
pretty soon.
Great.
Thanks so much.
I appreciate it.
That's it for this one,
but we're just getting warmed up.
Smash follow, send it to a friend,
or crank up the next episode.
Want to go deeper?
Hit us at pgpinecast.com.
Or find us on YouTube and socials at
pgpinecast.
And legally, none of this was advice.
It's for entertainment purposes only.
Bullshit!
See, Keith?
We read the script.
Happy now?