You're listening to the PT Pinecast,
where smart people in healthcare come to
make noise.
Here's your host, Jimmy McKay.
All right, some people build careers.
Some people build programs.
Some people build platforms.
Some people build podcasts.
Tonight's guest builds communities,
and that's different.
She's a physical therapist by trade,
but she refuses to accept that access to
care is accidental.
She believes neighborhoods actually shape
health.
She believes education shapes workforce.
And she believes we cannot complain about
workforce shortages while gatekeeping
Who gets into the profession?
She talks about rehabilitation deserts,
about isolation,
about the cost of forgetting that we
belong to each other.
And she designs education the way urban
planners design cities.
And that's with intentionality,
I just screwed up.
I'll edit this out.
Intentionality and with the future in
mind.
She's the founder of the Ujima Institute
and she's here to both inspire and
irritate you in the best ways.
Let's welcome to the show Lisa Van Hoose.
Lisa, welcome to the show.
Did you like that one?
I did like that one.
I was like, I want to meet her.
I was like, who is that?
I want to go have a cup of
coffee with her.
Wouldn't that be a cool exercise to do
with like a seventeen-year-old and be like
write a bio
of a man or a woman that you
would love to meet in twenty years and
then see what they describe and then go,
why did you describe that?
Well,
that's because that's what we kind of do.
Right.
I'm sure psychologists would psychologize
what I just did and be like, well,
yeah, we will become the thing you needed.
Right.
That's what we hopefully we become.
Right.
And then and then the exercise is how
do you go from here to there?
Now that you have the end,
how do you where you're not going to
do it overnight?
That person did not become that person
overnight.
What are the three things you need to
do in the next three years?
What are the things you need to do
in the next twenty years?
Yes.
And what is the delayed gratification that
has to happen right for you to be
able to become that thing?
Because we're so consumed with I want to
feel good right now.
And so then when things get hard,
people get a little nervous when you get
to the messy middle.
But that's where the development happens.
Seth Godin calls it the dip.
Some other writer calls it the suck.
They're like, it's going to suck.
I worked in a radio station.
My job was hang out, play music,
be fun, give away concert tickets.
And there were still hard parts of the
job,
parts that other people didn't see all the
time.
But I'll tell you, because we liked it,
we got through the suck.
You're able to show up.
put on a happy face,
and continue to do the things that needed
to be done when things aren't going right.
And that's sort of when you know you
found the thing that you're aligned with
or good at is it's always a job.
It's always difficult.
But when you're like, okay,
what do I need?
I need a big inhale.
I need a big exhale.
And I'll just keep doing it.
That's it.
All right.
So we lost you for a second.
Do we have you back?
Hold on just for a second.
That's so crazy.
So we lost you for a second.
But what I was saying was...
You know you're in a good spot or
you're doing a job that you're aligned to
do or good to do or want to
do when the suck shows up or the
dip shows up and you're still like,
this is hard,
but there's a reason for it.
I was having a call with a guy
yesterday.
He's a career coach.
Do you know Lucas Van Etten?
He's cool.
He's from Michigan.
He's a PT.
He does wild things.
He was just asking me questions.
He was motivational interviewing me.
And he was like, well,
what are you willing to like?
What if it was really heavy,
would you still lift it?
And he asked me this question because I'm
looking for like,
what do I do with my next twenty
years?
What job do I do?
And he was like,
if I checked like four out of five
boxes for you in terms of like how
much do you make,
what your day to day, whatever.
But you work for Samsung.
And I'm like, the TV company goes, yeah.
Would you take that job?
And I was like, no.
And he's like, why?
I'm like, there's no fight there.
Like there's no heart there.
There's nothing more.
I don't know.
Does the world need more TVs?
I don't care.
Like me.
I don't know.
No, I don't think so.
Like I have a TV, but that's it.
So it's like, I need,
I need there to be a thing.
I'm sure someone out there is like,
I love selling TVs and that's good for
that person.
That is not enough for me.
Yeah.
And I think like in Eastern cultures,
they talk about that, right?
That for longevity,
you have to have a purpose, right?
And sometimes in America,
we try to make purpose into like this
huge, big thing.
Right.
But they're like, no,
just what is it that brings you joy
every day?
And like you said,
it might be selling TVs.
But for you, it's this, you know,
connecting with people and being able to
spread messages.
But everybody's got to do the self-work to
figure out what their why is.
Why do they get out of bed?
I shared a post and this wasn't the
direction of what we were going to talk
about.
I didn't know it was,
but I have this slide always haltered.
You've heard about this, right?
The Aiki guy?
Yeah.
The reason for being, right?
And so it's three interlocking circles.
And let me see if I can do
it without looking at it.
It's what you're good at.
what the world needs,
what you can get paid for.
We'll get back to that one.
And then what you're good at,
what you love.
So being good at something doesn't mean
you love it.
Like I might be the world's best
bartender, but if I'm like, whatever.
So those two things are different.
And some people might poo-poo to get paid
for.
And I'm like, well,
you have to be able to support yourself.
Like good vibes doesn't pay the mortgage
and put food on the table.
So like,
are you providing something of value?
to get value out so you can support
yourself.
And the idea of the ikigai,
which anybody can Google it,
four interlocking circles,
those four things I just said,
where it crosses.
I don't even know if I'm saying this
right.
I need to talk to a Japanese person
because I keep calling it ikigai.
Ikigai, ikigai.
it's reason for being it's like when you
find the center of all four of those
that's your jam and that is a very
simple equation to say but it's not
necessarily easy to do because the world
is always the world is just changing like
a rubik's cube all the time and finding
where that spot is for you was always
different very true very true because i
mean like you know and simon sinek talks
about asking your friends right
Ask the people around you what you're good
at,
because we often most of us have been
conditioned through our trauma stories to
always think negative about ourselves.
So he's like, ask some other people like,
why are you my friend?
Why are you my neighbor?
Yeah.
Why are you my therapist?
Yeah.
I brought this up on LinkedIn for a
while,
sort of like pointing out to healthcare
providers,
because that's usually who I talk to or
I like to talk to on the internet.
And the pitch or the angle was like,
I see you talking about features of what
you bring.
And I want to not nitpick,
but I want to show you the difference
between features and benefits.
Nobody hangs out with Jimmy because he has
brown hair and he's five foot nine and
drives a Toyota.
I don't think so anyway.
That doesn't really bring my friends who
choose or not choose to hang out with
me.
That's not why.
But in healthcare, we're like,
I have a doctoral degree and I have
twelve years of experience and this.
I'm like, that is valid and logical,
but that's not why people come to you.
You are exactly correct, right?
Exactly correct.
I hang out
with you because of your shirt.
Like that is true.
I do love the shirt.
But I think we forget that we are
relational beings.
Yes.
And some of that I think is because
of the way in which we gate people
into health care professions where we only
allow you in if you have certain features.
Correct.
But then we know that those features don't
translate to bedside manner.
which is what the consumers are looking
for, right?
And that's what patients are looking at.
Exactly.
So it dictates outcomes more than
anything, your relational capacity.
Yeah, it's wild.
But I'm not in education.
You've been in education.
How would you include that in the process?
How would you do that?
So, Jimmy, let me tell you how.
Here we go.
I think that academic metrics are
important, right?
Because there is a correlation between
those and passing the MPTE.
But I really think a third of that
admissions has got to be what service
opportunities have you done?
Like, I'm like...
Admit every waitress, every busboy,
every porter that you know,
childcare workers,
like the people that have had to serve
others.
So if you've had to be a formal
or an informal caregiver,
like we need to value that commitment to
service.
Because that actually might be what turns
the tide between a good clinician and an
excellent clinician.
It's that ability to recognize and attend
to the needs of others.
And you're not always going to see that
in a GPA.
I did the things.
I brought the meal.
Why was that not a good service?
It's like, if you were a waiter,
you know.
I never made eye contact.
I never said anything.
My mood sucked.
You learn that.
quickly or you get beaten you get thrown
out like you're not i don't want you
here because that's really what you're
selling i can get a bowl of ziti
kind of anywhere
Um, I forget who was talking about that.
Oh, John Taffer.
He runs that show bar rescue.
So he's like a food and beverage guy
in Vegas.
And he's just,
he's like understanding the science.
And he's like the difference between good
food and great food is, is so small.
Right.
In terms of, of overall,
like what people view as a restaurant and
they go, but the different,
if you have great food with shitty
service, I'm never coming back.
Exactly.
Great service with like crappy food.
I'll give you another chance, right?
So I'm not discounting the quality of a
chef, but like even the chefs know,
if I put out this great meal and
you act like a jerk, I got nothing.
Why do we treat healthcare differently?
Is it because it's formal?
Because it's science-y?
Because it's more, I don't know.
Why?
Why is that?
Well, I think somewhere during history,
we tied healthcare with mobility, right?
It kind of became this artificial royalty
to, you know, this person is the doctor.
It doesn't matter how they treat me
because I'm just getting seen by the
doctor.
It's kind of like I'm getting to go
to the king, right?
And unfortunately, right now, health care,
just like education,
you get paid regardless.
Yeah.
If it's crappy care or not,
you get paid regardless.
Uh-huh.
I had an article about that not long
ago on LinkedIn,
and I got a lot of I agrees,
and I got a few like, well,
that's not the case because...
And they were going one level deeper.
They were like, well,
if I give good care or quality care
or good experience,
people will come back more often.
Yes, agreed.
But then the person giving...
mediocre care will just be like,
I'll just spend a little more on ads
and I'll just keep giving mediocre care.
And I understand I'm going to put nothing
into it.
So my margins are going to be better.
And it sucks.
I was trying,
I wasn't trying to dunk on anybody.
I was trying to show you like,
this sucks.
Like I can do a crap,
a C minus job and you could do
an A plus job.
We get paid the same.
And that, that isn't okay.
We should be mad about this.
Not trying to find the fault in my
arguments.
And we should be mad about it because
where those mediocre and sometimes not
even mediocre,
just subpar clinicians end up is in rural
and underserved areas where, you know,
if you were to just think about,
you know, just basic things,
You know, equity.
If you've got an area that has higher
complexity and acuity,
you would want the best practitioners to
be there because they're going to be more
effective and it's going to ultimately end
up costing us less.
But if you keep sending mediocre and
subpar clinicians and practitioners to
those areas, then, yeah,
health care is going to be trillions of
dollars in debt because those people
aren't incentivized to be effective and
efficient.
They get paid regardless.
Right.
So if you are out here in Joe
Schmo, you know,
Louisiana and there's one cardiologist,
it doesn't matter.
Because that one cardiologist is still
going to have a full caseload and they're
still going to bend over their back to
make sure that that cardiologist is taken
care of.
Because they're going to say some service
is better than no service.
And I am of the belief that no,
it is not.
No, it is not.
You've talked about something that I don't
even think I learned about this term until
after I graduated.
I think it was Patrick Berner who taught
me a couple of these terms.
And the term was, he used food desert.
We're going to talk about rehabilitation
desert.
First of all,
define it because I don't want to act
like everybody knows what it means because
I had never heard those two words put
together for a long time.
So what is a rehabilitation desert?
What does it mean?
And how are we or how is the
system contributing to it right now?
Right.
So deserts basically are and you can use
it with any adjective on the front end.
Right.
So you'll hear people talk about medical
deserts.
You'll hear food deserts.
You'll hear transportation deserts,
rehab deserts.
But any time there is an area where
access
is either limited or not available.
And so the individual has an unusual
burden to be able to try to access
care.
And we know that there's a sweet spot.
So people will normally tolerate about
twenty minutes of commute.
So if I want to go see a
PT,
if they're within a twenty minute drive,
I will go.
But if it gets to twenty five,
thirty minutes,
my brain starts to think this is too
much.
And so we know that there are areas
where people,
they may have to travel hours to see
a PT.
Or if you start talking about PTs with
specialty or advanced practice,
I know that there were times I would
have clients that would drive four hours
one way to see me because I was
an oncologist specialist.
And like here in Louisiana,
I think there are two of us for
the entire state.
Why?
When I'm thinking about where we're
putting future PT programs,
they need to be in areas where we
can address rehab deserts.
Or even if they're hybrid programs,
then programs need to be able to say,
how are you intentionally admitting people
that are going to help us address these
rehab deserts?
Well, they need to be able to stay,
right?
You've obviously thought about this,
so I can ask you questions left, right,
and up and down.
Let's say you put
a rehab,
a PT program somewhere where they need
PTs.
Right.
And then you get people from that
community to go to that program and pass.
What's to stop them from going, hey,
I just got out.
I have now the ability to leave.
Would I not take it?
How do you get them?
How do you incentivize them to stay?
Exactly.
Yeah.
So what we've learned from medicine and
what they're doing with rural health is,
is number one, from your admissions,
you need to admit people from those areas
because they've already got an anchor,
a root in those areas.
And then their clinical education needs to
be back in that area.
Right.
So if you can recruit from that area,
educate them in that area,
they are eighty three times more likely to
stay in that area.
Right.
Eighty three times more likely to stay in
that area.
And then what we know from neighborhood
science is that what most people want,
right,
is they want decent education for them and
their children.
They want a grocery store.
They want a bank.
They want health care access.
So that's where PTs and PT educators,
when we're thinking about where we're
placing our programs and placing our
clinics, we're just like we just got to.
think about us.
No,
you've got to think about the environment
as well, right?
And what it is that you need to
do as an educator or a clinician to
make sure that there are things in that
neighborhood or in that community that
will make those graduates want to stay.
So it's hard for us as PTs to
talk about mobilizing society if we don't
think about a bigger society than what we
do as PTs.
That's talking a lot about who feels
welcome in PT.
We talked about this years ago.
If you don't see someone who looks like
you, walks like you, talks like you,
why would you ever think that that's a
place for you to be?
Putting a program there probably opens
that door.
But there's a lot that goes into that.
Money.
Who's going to be the people who you
now move to that area to teach the
program?
If it's truly rural and care is scattered,
where are they going to do their clinical
rotations, right?
Are they going to have to travel two
hours one way or are they going to
have to move to do a clinical?
And then you've sort of defeated the
purpose.
So this feels simple but not easy.
Yeah, it's not easy.
So it takes a lot of planning on
the front end.
But that also is part of the experience
of those clinicians that are providing
care to rural and underserved areas is
you'll hear many of them say that a
lot of their job duty is traveling, right?
to the next county over,
to the next city over.
And so there's a part of training, right,
this workforce that's gonna take care of
the underserved to understand that that's
gonna be part of the burden until we
can get enough people interested in rural
and underserved so that you don't have to
travel more than twenty minutes as the
practitioner or as the consumer.
But I also think that we're not leveraging
technology.
Because like telehealth,
remote monitoring,
there are all these other ways in which
PTs are providing care and also
community-based rehab, right?
So all PT doesn't have to occur within
a clinic.
It can occur in a patient's home.
It can occur within a community center.
So I think we've got to get ourselves
out of a box because a lot of
this we've created ourselves.
Where do we steal the innovative ideas?
Like when you're mentioning some of that,
I've done some, you know,
interviews with people who work in Alaska
or, you know,
in the Pacific Northwest where being rural
is just way of life.
It's like, you know,
necessity is the mother of invention.
It's like, well,
if you want to figure out how to
solve a problem,
go watch people who've had to solve it
as a way of life.
So are we able to steal some ideas
from those types of practitioners?
Oh, yeah.
I think if we were to have conversations
with nurses,
I think nurses have been really innovative
in how to deliver care.
I think your old school rural health
primary care providers,
they know you got to be boots on
the ground.
But ultimately,
I think having conversations with the
community members, with the neighbors,
because community knows what it needs.
What happens is,
is we will go have a conversation with
them and then we go, oh no,
they just don't understand how we do what
we do, right?
But a community member will tell you,
why can't the PT be in the barbershop?
Right.
Because I'm going to go get my hair
cut and I'm probably going to have to
sit there and wait thirty, forty minutes.
Guess what?
I could be doing my I could be
doing my treatment while I'm waiting.
Right.
Yeah.
Why?
Why do I got to go down the
street to you and then come back and
sit in the barbershop?
I mean,
like community will tell you how to
improve access.
It's just whether or not if we'll be
humble enough to listen.
If you pay attention and if you're willing
to change to it versus asking or demanding
that it changed to you.
I remember learning this lesson about a
bicycle when I was in PT school.
I bought a bike on Craigslist because I
couldn't afford a new bike.
So I bought someone else's old bike.
I was like, I'll buy your mistake.
Like, no problem.
I'll get a three thousand dollar bike for
nine hundred bucks.
I'm not an idiot.
And I rode that bike for two years
in races.
And then someone watched me on the bike
and they were like, why do you,
you know,
it's one of those like where you lay
down triathlon bike.
Like, why do you,
why are you like this?
And your wrists are like this.
And I'm like,
cause I have to touch the controllers and
they go,
there's a screw right there that would
make those arms longer.
And I was like,
I've been doing this for two years.
I adapted.
I got smaller for the bike and,
without knowing the bike was already
designed to adapt to me.
And I remember I was going through,
I think neuro and PT school.
And they were like,
you don't ask someone to adapt to the
power wheelchair.
You adapt the wheelchair to them.
It works for you.
You don't work for it.
I remember like as dumb as a bike
metaphor being like, Oh,
you should look at this for everything.
Like,
This should work for the person.
The person should not have to bend or
shrink or twist or turn for the system,
for the bike, for the wheelchair,
for the curb cut, for those things.
Is medicine or is healthcare,
are we just this big establishment that
we're just like,
this is how we provide it and you
will be glad how we give it and
you will say thank you and you will
go on your way?
I mean, is that it?
So I think that is it.
And I go back and forth because I
feel like some of that is rooted in
this philosophy of what it means to be
a great American, right?
because we tell people that the American
dream is all about individualism and you
pulling yourself up by the bootstraps,
right?
So yeah,
you've got this healthcare system,
guess what?
If you're a good enough American,
if you're a good enough individual,
you'll figure out how to make it work
for you, right?
But in my learning more about Blue Zones
and the research around it,
what they are talking about is that that
is such a fallacy.
It's not the fact that these people are
uniquely different than the rest of us,
and that's why they're living to be a
hundred years.
It's because their environment is
different.
Right.
So they're like,
why can we not learn how to adapt
environments so that then we make healthy
lifestyles easy for people?
And it's the same thing with education.
Why can we not adapt the educational
environment?
to make learning easier for the learning.
Why can we not adapt the healthcare system
so that it works better for the
individual?
But we have this fragmented healthcare
system that we go, this is great.
You go figure it out.
And if you can't figure it out,
then you get to die or you get
to be sick or you get to not
have your quality of life.
It's your fault.
I remember when someone pointed out that
phrase, because like cliches,
become cliches because they get repeated
so much right doesn't mean they're
necessarily true but the fact that like
can you show me how you could sit
on the floor and elevate yourself by
pulling your own bootstraps up that
doesn't work give me the best Cirque du
Soleil athlete and that does not work you
cannot do that like that does not work
I get the sentiment I'm not trying to
nitpick the cliche but
People,
if everything you're saying is true,
which I also agree with,
design the community where they don't have
to pull themselves up,
that there's a path to walk that's simple
that also benefits themselves and others.
That seems like an easier way to do
it.
It makes sense to me because I'm like,
if we're all out here pulling ourselves
up, then why are there country clubs?
Why is there golfing?
Right.
Why are there cigar bars?
Because what those things signify is that
there are places where people come into
community and then they network and they
help each other out.
Right.
So I'm like,
so just normalize the fact that no one
really is doing this on their own.
Right.
So but if we can keep telling people
that they just need to keep you just
keep doing more, then, you know,
people will keep striving to do that and
then they'll pay for all of these services
or processes that don't really work.
So I'm just like,
we just need to be honest about the
fact that our health care system is
fragmented.
It does not work for most of us.
It costs us way too much money and
it's ineffective.
And we do need to have an honest
conversation about that.
Because we created it.
And if we created it,
we could fix it if we wanted to.
It's one of my new favorite quotes I
got from a guest, Rob Pinarello.
He said, it might not be our fault,
but it sure is our problem.
Which is like,
you might not have created it,
but you still have to deal with it.
Which also means,
but if you can deal with it,
If enough of us decide to change it,
that's the only time that something
actually gets changed is when enough of us
decide that it gets changed.
Yeah.
And see,
and I kind of see it as binary.
And this might be way too simplistic
because I kind of see it like life,
right?
So either you're living,
you're either actively living or you're
actively dying.
Shawshank Redemption.
And so to me,
you're either actively creating it,
even if it's bystander creation,
or you're actively changing it.
Which one are you doing?
You're going to let it continue to exist
as it is and you're like, that works,
or you're going to change it.
Yep.
This also works against clinicians in the
healthcare profession, right?
Like this lack of connectivity or
isolation or individualism,
like staff culture or like, so, I mean,
we have, I forget what the statistic was,
but a large number of our colleagues come
into this profession and I think it's
seven years later
they last seven years.
It's like,
you just went to school for essentially
seven years to hang out for seven years
and then leave.
And that's a lot of wasted effort and,
and skill and insight.
And that feels like we could,
we should fix that.
Yeah.
And it's interesting,
like why people are leaving and that
number may even get lower based on what
we're seeing in, in,
these last two youngest generations of
PTs, that number may continue to drop.
But it's like people are leaving, right?
Sometimes it's, you know,
family obligations, right?
They're at a different season in their
life.
But a lot of times it's pay.
A lot of times it's the workplace
environment, productivity,
insurance burdens, administrative burden.
But all of those things we could change
because at the end of the day,
There is a PT manager.
A lot of times there is a PT
owner.
And then even in these larger companies,
there still are PTs in the C-suite, right?
So once again,
I keep coming back to the fact that
I'm not going to say that everything's
easy, but I'm going to say,
but we still are in change agent seats
where we could change it if we so
wanted to.
Is it going to be painful?
Yes.
Are some people going to have lower
margins?
Yes, for a little while.
But it's like,
are you willing to have some short-term
discomfort to protect the profession?
And also to just be kinder to that
fellow human, right?
So you've had a graduate work seven years
to be part of the profession.
They get out, they graduate,
and then they only work seven years.
I'm like, come on, right?
Like we're missing out on so much
potential because we're losing these
amazing humans that might be our future
leaders.
They might innovate something for the
profession,
but we end up losing them because we
want them to see sixteen patients in one
day.
I'm just like,
That instant gratification.
I'm just like,
could we not be reasonable with
productivity expectations?
Could we not be flexible with work hours?
Because it's going to cost you more to
replace them.
I was going to say, if you don't,
what is the cost?
You've said this,
we're gatekeeping the profession while
complaining about the shortage.
Yeah.
That feels like we're talking in circles,
right?
It's talking out of both sides of your
mouth.
There's not enough people,
but we're gatekeeping.
So what do we... Well,
and then there's the middle part,
which is how do we keep people in
the profession longer?
So you have input, you have throughput,
you have output, right?
In terms of someone's career span.
You're focused on input because you're in
education.
Well,
I shouldn't say just focused on input,
but you're like,
how do we get more right people into
the profession?
Because more right people is better than
more not right people.
Because if those people aren't right,
they might not stick around and prevent
them from leaving the profession.
Yeah.
And I am of the belief now,
and this is where people will get
irritable with me,
every four point O student is not the
right person.
Right.
I think there is some beauty in having
conversations about those people that
represent the three point three point
three because their drive is different.
Right.
Their passion about the profession is
different because.
There's just a gratefulness to being
allowed access.
That then they're like, you know what,
I'm going to stay in this because I
am grateful to have been able to be
here.
I, you know,
I know what I've had to do to
be able to get to this point where
we tend to only think about the three
point eights and the three point and the
four point O's is on my, you know,
think about all they've done.
Yeah,
they've done a lot from an academic
standpoint, but that that drive, right,
that I don't even know what to call
it, but that grittiness,
I tend to see that more in the
three point O's to the three point threes.
And I also tend to see them stay
longer within the profession because they
feel a commitment to the profession.
They feel like the profession took,
you know, they, they took one for them.
What,
what would be a better word for Jimmy?
But I'm not saying that something was
given to them, but they just,
there's a different sense about being
accepted into the professions.
Well, for a second there,
I was going to say it's an effect
called the IKEA effect.
Have you ever heard of the IKEA effect?
Lego effect?
Because I had more...
I had to construct this coffee table.
I actually valued the coffee table.
It was in Betty Crocker cake mix.
All you used to have to do was
add water and people said,
it didn't feel like I was doing enough.
They literally said,
you have to add water and egg and
adoption went up.
So it was like,
if you have to do a little more,
if you had to sort of sweat a
little more or put a little more work
into it,
you might feel like it's worth more to
you.
Right.
Personally.
That's a great way to put it.
Because I do want humans to feel like
they are the gift, right?
We all have been called into existence for
a reason.
But I also think that your profession,
and especially professions that have
selective admission,
recognizing the gift that has been given
to you.
And I do sometimes find that those
candidates with the higher GPAs,
they feel like they're the gift.
And if things don't go a particular way,
then they're ready to go.
And granted, many of them do have options.
So yes, utilize your options.
That's not what I'm saying.
But I just find that the persistence and
the perseverance is not the same.
And I realize I'm speaking in
generalizations.
Right, right, right, right.
But I just hear so many educational
programs talking about they want the
qualified student.
And in their mind,
the qualified student is three point five
or greater.
I'm like, no, the qualified student,
if your document says it is three point
oh,
then it's the three point oh student as
well.
So you need to wrap your arms around
them.
And what I have just found is that
they come with a different set of
attributes that actually ends up.
being better for the profession.
There's just a resilience there.
There's just a hunger there that's
slightly different.
What would it look like if PT education
truly centered community instead of
competition,
instead of a four is better than a
three five?
Oh, you know,
I would love for it to get to
the point where if you've got the academic
metrics,
then
Good we're done with that part right
that's your screening,
then the rest of the admissions process is
really looking at those attributes that
you have towards the ability to build
community right.
So even I would love to see community
members participating in the admissions
process.
Right.
What would that look like to have patients
sitting on the admissions process to be
like, oh, yeah,
that person could be my therapist or oh,
no.
Did you notice the way in which they
spoke to us?
Right.
I think I would love to see the
end users helping us select the future
clinicians.
Yeah.
I mean,
I learned that in a different way when
I worked for Mount Sinai Hospital and
David Petrino was in charge of a research
lab and he used to use this phrase,
which he didn't coin, but he said,
nothing about us without us.
And that was from the disability movement
back in the sixties and seventies,
which is you have people making decisions
about other people and no one in that
decision-making process has the disability
that we are deciding on.
And that doesn't make any sense.
Right, it doesn't.
And that kind of comes from
community-based research.
Some people call it community empowerment
research.
You're now hearing terms like asset-based
models.
But this concept of if the end product
is a practitioner,
then I think there needs to be some
changes in our processes to say,
and be it education or clinical,
at every time point,
Where is community part of this
decision-making?
And so there is an organization called
PCORI,
which is Patient-Centered Outcome Research
Institute.
What I love about that organization is if
you are designing a research project,
community's got to be involved from
conceptualization all the way to
dissemination.
And I think that PCORI model,
we need to embrace that in healthcare and
clinical services.
We also need to embrace it in education
where if you're designing this and
communities who it's going to impact at
every timestamp,
where's your community member?
Where's your public member?
I saw it in practice when I said
at Mount Sinai,
we'd have technology companies come and
say, we've solved insert disability here,
or we've solved this problem for this
subset of the population here.
And David, he was also Australian.
So whenever he talked,
it just sounded cooler.
He'd just be like,
he would ask just like stunningly simple
questions.
Who from that community is on your board
who's actively been in the process of
this?
And a lot of times,
these were David's words, not mine.
He was like,
it's a bunch of tech bros going,
we figured it out.
And the answer is nobody.
Right.
And then he,
David would then just simply turn to
people who had that disability and say,
is this in your top twenty five problems
that you face every day?
And they'd be like,
not even in my top fifty.
And they're like, what are we doing here?
You've solved nothing.
And from and from like psychology and
sociology research,
we call that saviorism.
Right.
Where it's totally you thought there was a
problem.
and you were like,
I'm gonna come up with a solution.
And then you take it back to community
and you're like, I'm the best.
I fixed this for you, right?
And we also do that in education where
faculty will get together and be like,
this is what's wrong with this course or
this curriculum.
and very seldom do we get feedback from
the students like really good feedback not
just the student eval at the end of
the year but sitting with students to talk
about curriculum and then we go we fixed
it and the students are like no it
still sucks right and then when you think
about like clinics and patient care like
often you'll hear people say we have
community advisory meetings yes but they
meet once a quarter
Right.
How often do you invite community members
into your staff meetings to talk about,
hey, how is this really going?
Like, sit down and have conversations.
But a lot of times we're doing things
because it feels good for us,
not that it really helps the situation.
Yeah.
Because I have a use case where I
think it happens.
I don't think it's on purpose.
A lot of times.
APTA state chapters and academies.
I see you.
I love you.
I want you to succeed.
It might seem I'm harsh on you online.
That's because I'm trying to push you.
Some of them will do town halls.
And I'm like,
I don't know if that's the greatest way
to get feedback because a person has to
stand up in front of a group of
peers and say something that might be
super personal.
The funny part is...
It's probably more than that person
thinking it,
but is that the best way to get
feedback?
Probably not.
And here's my non-scientific way.
We've all been to presentations.
We just came back from CSM.
Someone talks for sixty minutes.
Everyone says, clap, clap, clap.
Any questions?
Maybe one or two.
Clap, clap, clap.
Thank you.
I'm done.
And then twelve people rush the stage to
ask a question.
Where was that?
Forty eight seconds ago.
Why?
I know why.
Because they didn't want the spotlight.
But that's where really interesting things
happen.
So, yes,
asking for a survey at work or at
school isn't the best way to get the
right feedback.
No, no.
It's that one-on-one small group.
I mean, and people are like,
but do we have time for that?
If you want to know the,
if you want the answers,
you have time for it.
Right.
And do you have time to not do
it?
That part.
And nowadays, even with technology, right?
So there's so many audience engagement
systems that you can still protect
someone's need to feel safe and allow them
to still give you feedback.
I'm just like,
but we often design things in a rush
or either we're just thinking about how
we've always done them.
We're not really thinking about universal
design of, okay,
how can I engage as many people as
possible?
Because if you want as many perspectives
as possible,
you've got to be much more intentional in
every aspect of the human condition.
I would say these are communication
principles, right?
And I love stealing that fit VP model.
Everybody's like, oh, frequency,
intensity, time, type, volume,
progression.
I go, those are exercise principles.
Those are also communication principles.
Those are relationship principles.
Those are all the principles.
Those are the only levers you can pull.
Oh, that's good.
I had not thought about that in that
way, but that's really good.
You would say low frequency,
but high intensity.
That's a town hall.
So that might be good.
It might be good.
But would you need small groups quarterly?
That's more frequency, but less intensity.
What about a one-on-one that meets every
three weeks or monthly?
That's higher frequency, less stakes,
right?
Yeah.
And...
I come from the land of frequency,
like quite literally radio frequency,
but like, that's not what it,
that's not the frequency has to do with
wavelength,
but how frequently do you show up and
ask?
Yeah.
If it's once a year,
are you shocked when you don't get good
responses?
And when you put it like that,
you're like, well,
obviously my door is always open.
That might check a box, but,
But if I don't know,
if I feel weird about walking through the
door,
I don't know how to start that
conversation.
Hi, I'm here to complain.
Like, no, I don't want to do it.
But if you're asking, I don't know.
Like frequency is always the lever in my
mind that I like to pull on first.
No, that's a great point.
That's a really great point.
Really?
I didn't think that was,
but I'll take it.
No, it was fabulous.
And I teach electrofizz,
so it so made sense to me, right?
Because I'm like,
I can have the electrodes on you,
but if there's not enough beats coming in
or enough hertz, I'm not going to get,
yeah, it's not going to do anything.
So I felt that.
Great job.
You said we will not survive if we
focus only on self.
So let's look to the future.
There's no good story unless there's
tension.
What happens if we don't change?
For the profession,
I'll frame it that way.
As the profession,
if we continue down the path we're doing
and we don't take any of these things,
heat of any of the things that we
just talked about, what is the fallout?
What does it look like when we fall
off a cliff?
So here's the world according to Lisa Van
Hoose.
So this is just my opinion.
I do recognize that I represent other
organizations, but this is my opinion.
From an education standpoint,
PT programs are going to close.
There's just not going to be enough
interest.
If we cannot figure out a way to
lower costs, lower the cognitive load,
I'm not saying decrease your credit hours,
but
You've got to make sure that instruction
is delivered in such a way that it
reduces cognitive load and reduces the
trauma during the learning process.
If we cannot figure out a way,
students just aren't going to come to our
classes, right?
And I feel very strongly about that
because there's too many options now,
right?
This is not the nineteen fifties.
It's not the sixties.
It's not that, you know, there's only
Fifty disciplines in health care.
There's over two hundred disciplines in
health care.
So if somebody wanted to be in health
care,
there's all different kind of ways they
can participate.
So we've got to get more attractive from
an educational standpoint.
From a clinical standpoint,
I think we are saying the wrong message
because right now the message is about our
features.
So I'm going to use what you said
earlier, right?
We are a doctoring profession.
We have done seven years of training.
We are in the community, right?
It's a lot of we messaging.
People do not, like,
even if you're in a room with another
individual and all you hear them saying is
I, I, I, like,
we don't like talking to that person.
It gets creepy, right?
So if the message was, you know what?
Here's how PT is changing lives.
Every state has a state health improvement
plan.
If we made sure that every clinic was
addressing at least one measure from the
state health improvement plan,
then we can say back to states,
you know what, we see you.
We heard that this was a priority.
This is how we're contributing.
That's a different message than we've done
all these things.
And for that reason,
you need to take care of us.
It's like, no, we are an asset.
You said this was your problem.
Here's the assets we're bringing to the
table.
And then naturally people will want to
partner with you and people will want to
make sure that they take care of you
because you brought value.
I think sometimes our doubling down on
self-advocacy makes us come off as really
selfish.
And it's hard to sell a selfish message.
So I really would love to see us
focus more on public health community
messaging.
And I think that would do us better.
so i am afraid that within the next
five years if we don't do some things
quickly we're going to see pt programs
closed down some people are excited about
that because they're like supply and
demand i also think that if our messaging
does not change then what we're going to
see is we're going to see other
disciplines that have better messaging
they're going to get to move into spaces.
And we're going to be like,
why is the athletic trainers there?
Why is the exercise business there?
Well,
because they had a community facing
message.
The other thing that makes me really
concerned is there's this big push to
create PTs faster.
We're not making widgets.
We're not making, I don't know,
Something production wise we're not making
tires right you're making humans who have
to have a certain amount of relational
capacity.
And we already are taking them from
bachelor's degree right to doctoral
degree,
we know from neuroscience that there are
parts of their brains that control empathy
and compassion are not fully developed
until they're somewhere between.
To.
So why are we moving so fast, right?
If the issue is that we need to
get practitioners out into the clinic
earlier, then let's talk about that,
right?
So maybe it is time that we start
talking about, you know,
some type of tiered licensure setup so
that
They get their bachelor's degree.
Maybe they do their first year PT school.
Then after that,
they go to work or maybe they,
while they're getting their bachelor's
degree,
they become a PTA so they can go
work.
Right.
And then once they've been in the field
for a while,
then they come back and work on their
DPT.
But this fact that we're going to take
an eighteen year old and in five years
at the age of twenty three,
turn them into a doctor or PT.
and they're going to be a safe clinician,
and safe clinicians is not just about
technical skills,
it's also about relational skills.
I'm not sure if that's true.
We just are not respecting the social,
what they call socio-emotional literature,
that there has to be time for development.
We know that from a rehabilitation
standpoint, right?
Where we will respect some six and twelve
weeks of healing time,
But then we don't want to respect that
from a brain development and a cognitive
learning time.
So I think there are other ways we
could address the practitioner need
question without Russian half-baked
clinicians to the clinic.
But that's my take on it.
Like,
I once want to hit a gavel and
be like, Lisa has spoken.
If I had a microphone, I'd drop it.
I don't want to drop it.
I'm like,
nobody likes half-baked anything.
So stop it.
Um, we were together at CSM in, uh,
just a couple of weeks ago and you,
uh,
got an award and I like talking about
awards.
I like talking about awards for what we
did to get, like, what was the thing?
What was the purpose?
Share what you did to get,
because you didn't do the thing to get
the award.
You did the thing to do the thing.
And then the Academy of Leadership and
Innovation was nice enough to recognize
that.
And here's why.
Number one,
you deserve some accolades for doing that.
But also,
we want other people in the audience to
be like, oh, look at that.
How do I do that in my way?
So talk about what you did.
Yeah,
so I was super honored to be recognized
by my peers for helping to build an
environment that supports mobility, right?
From all the domains of mobility,
physical mobility, emotional mobility,
social mobility, financial mobility.
So what the Ujima Institute does is we
partner with communities to say, hey,
what are the problems, right?
What is keeping you from being able to
live your best life?
And what we found in our neighborhood was
it was childcare, youth services,
food insecurity,
and then just basic health literacy.
And so we went about doing those things.
So we offered a childcare service.
We had youth programmings.
We trained young teenagers how to take
vital signs and how to serve as healthcare
workers so that they could go to
appointments with their loved ones.
and be able to be like,
this is what these words mean, right?
Because we, ooh,
this is finna get political for a minute.
So we know that when people have improved
health literacy and they go into a
clinical appointment and they say
hypertension,
Right.
Not high blood pressure.
Health care workers pay attention.
It's just like with your children.
What we know is that if your children
knows the word vagina, penis, vulva,
they are less likely to be sexually
assaulted because the predator knows that.
Wait a minute.
That child is talking to somebody who's
talking to them about their body parts.
Right.
So it was really important to us that
community members knew the words.
so that then they would get the attention
of the healthcare worker because then at
that point they got better care.
And what was crazy about it was that
community members would come back and go,
I've gone to that doctor for ten years.
That was the first time that person sat
down and listened to me.
So we created a healthcare worker system
where
Someone could call.
They could say, hey,
I'm going to go meet with my cardiologist.
This is what's going on.
What questions should I ask?
And we would help them come up with
the questions and help them come up with
the words or find the guidelines, right?
That's the other thing.
We were like,
start asking your health care workers,
what guidelines are you using, right?
So your mom's had a stroke.
Ask them which stroke guidelines they're
going to follow, right?
That gets the attention of health care
workers.
And so
These were things that the typical person
would say, but that's not PT service,
but it is, it falls underneath self-care,
right?
So if people can't live in environments
that support their life,
then it's hard to have a conversation
about, yeah,
come see me in the clinic two to
three times a week for your low back
pain.
And they're like, I'm trying to, you know,
have enough food and make sure my kids
are safe and everything else.
So
Is maslow's law,
you know you got to deal with those
basic needs first before you can start
talking about tertiary care and so.
we've been able to work with Community to
do those things and so like now we've
got a Community garden we're trying to
figure out our summer youth programming
and we just finished.
because we just had a pretty bad ice
storm here.
And so Ujima was able to mobilize with
three other organizations.
And over the course of four days,
we were able to deliver four thousand
meals to people when they were without
power.
And that like if you want to talk
about bringing value to the profession,
people are like that physical therapist
over there, like that's Lisa.
And if you have a need,
she can help you.
Right.
So it's not just about
you just come see me if your knee
hurts.
It's like, if you got a need,
that's a healthcare person that can help.
And that, that is you, that's invaluable.
That's invaluable.
So, yeah.
I can't let you leave without giving a
nod to Ujima.
Just give a quick mention about what is
it.
And then we'll put the website in the
show notes.
yeah so ujima is basically the third
principle of kwanzaa um it means
collective work and responsibility so in
layman's terms my brother's problems are
my problems my sister's problems are my
problems that humans problems are my
problems um so don't turn a blind eye
to people so and then and do what
you can every little bit helps i'll share
the uh the website there well hey
congratulations on your award
I knew you wouldn't want to come on
the podcast to talk about an award,
but we'll talk about other things and then
the work that went into the award.
Yes.
Now, here is where Ujima needs help.
So let me tell y'all where we need
help.
So as I said...
one of the things that community has said
that they needed is childcare services.
So what we did in the past is
we actually did like your traditional
childcare set up, right?
So when you think about childcare,
you know, you take them to a center,
they're with you from seven to five,
you've got childcare work, um,
childcare workers.
Margins in childcare centers are very
small, right?
They're anywhere between five to fifteen
percent.
Um,
And that is not manageable because what we
tried to do different in Ujima was we
knew that the household,
the median household income.
So typically your child care should be
between five to ten percent of your
disposable income.
That meant that weekly child care roughly
needed to be between one hundred and
twenty five to one hundred and fifty
dollars a week.
Right.
That is half the price of what other
child care centers.
Yeah.
So that was not a sustainable model.
So you have a group of amazing,
brilliant people that follow your show.
What would be a model where we could
still provide all day services for
families, but it not be child care?
So like some of the things we've thought
about is could we offer it as a
wellness model, right?
That you drop your child off at seven
o'clock in the morning and you can pick
them up at five and we're going to
work with them on their wellness and
physical activity, right?
Something where it's not child care.
um because the child care industry is so
over regulated so that's the other part of
it is that there's so many fees and
everything else associated with that that
that's part of the reason why it has
to be so expensive um so we're trying
to figure out is there another way to
do that some people have talked about you
know could we do a parent co-op right
where parents then become the co-workers
but if y'all got ideas about how we
could provide all-day child care services
for that pre-K through four-year-old group
or even infants to four-year-old groups.
That would be greatly appreciated.
What's some innovative ideas out there?
I'll get on it.
I'll call you back soon.
I'll be on it.
I got faith in you.
Yeah.
Last thing we do, Lisa,
is called the parting shot.
What's the thing you'd want to leave as
your mic drop moment or your soapbox
statement as we wrap?
Yeah, if you're not part of the solution,
you're part of the problem.
Either you're in the boat and you're
rowing or you're an anchor.
Lisa Van Hoose,
thanks for doing what you do.
Thank you.
Thank you always for your time.
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.
Bulls**t!
See, Keith?
We read the script.
Happy now?