You're listening to the PT Pinecast,
where smart people in healthcare come to
make noise.
Here's your host, Jimmy McKay.
If I had a time machine,
I would go back.
I wouldn't name it PT Pinecast.
That was a goof.
This was because we drank beers after
class and we're like, oh, I get it.
We want it to be fun and like
a happy hour.
I don't even, I mean, I like beer,
but I don't love it.
Like people like,
they want to talk to me about beers
and I'm like, I don't know, man.
I like regular beers.
It's not my identity.
That's my problem.
But now that beer follows me everywhere.
Although it is good at CSM because you
know what people...
When they see me walking through the hotel
bar, everybody wants to buy me a beer.
So I saved myself a couple of bucks.
Rebecca Griffith, Drew McKay.
We were just chatting before we hit go
live.
You got a... Someone commented.
They didn't DM you.
They commented on something.
So set the story up.
And I was going to put the thing
on the screen, but I don't want to...
I don't want to blast the person.
Yeah,
I don't want to put this person on
blast,
but let's talk about the reason this
person...
Yeah,
so kind of the context is I posted
a video about the difference between an
emergency department physical therapist
and an acute care physical therapist.
Got it.
It's a question that I get asked, like,
how is that different than regular acute
care?
How is it different than an outpatient PT?
And so it was really just sort of
clarifying that.
And then the person just sort of said,
like,
sounds like a physical therapist who works
in the emergency department.
There's no such thing as an ED physical
therapist.
Which, you know,
if you want to split hairs, fine.
I personally feel like a physical
therapist, no matter where you are,
you're a physical therapist.
I'm fine with that.
That's okay.
But then the person went on to say
in the hospital,
we're all just physical therapists.
There are no specialized PTs in the acute
or emergency department world,
whether we're ED or acute,
we're all just discharge monkeys.
And that made me really sad.
In the Oxford debate at CSM this year,
too, for the acute care academy,
the question was, float or focus?
Should we be generalists or should we be
really specialized in the acute care
world?
But I think what bothers me here is
that I feel like this person has lost
their agency.
Yeah, like their way.
Yeah.
And I feel like a lot of physical
therapists are feeling like that,
regardless of the setting that they're in,
whether they're in the rehab setting,
the acute care setting,
the home health setting.
I feel like we're all sort of feeling
like we're practicing the way that we're
told,
not the way that we could or should
be practicing.
So number one, I'm on purpose,
like just being quiet,
which is painful for me,
but I'm going to jump in now.
So like this person is having a bad
experience where they are.
So like, I think this person,
that's why I don't want to put them
on blast as the kids say,
I don't even know what the kids say
that anymore.
This sucks.
Like this part, like, okay,
so let's unpack.
The person actually said there are no
EDPTs.
There's no difference.
Listen, Rebecca is not, you are special.
but you're not special because you work in
the ED,
but there are some skills you pick up
there versus working in peds or
geriatrics.
We are all PTs.
Yes.
You're just playing a different position,
right?
Like I'll use a sports analogy.
We're both baseball players,
but if you put Jimmy at third base,
that doesn't make any sense.
Right.
I could learn it maybe,
but I'm also left-handed.
That doesn't make any sense.
But anyway, I digress.
This person's in a bad,
this person's in a bad system, right?
And maybe they're too far gone.
Maybe they're just like, if we're like,
all I am is a discharge monkey,
I'm really sorry you feel that way.
Well,
and that was exactly how I responded.
I literally said,
I'm really sorry that's been your
experience.
Yeah.
You're in a bad system.
That sucks because I also don't think this
is isolated.
I think a lot of people will start
to feel like this.
No,
and I know there are more trends in
the acute care setting where physical
therapists are told that you can't make a
specific discharge recommendation.
You can't say acute rehab or sub-acute
rehab.
You have to say post-acute rehab or,
and that's not isolated to any one
hospital system.
I've been hearing that from people across
the country.
And the reason for that,
like if we really stop and think,
is it to strip physical therapists of
their autonomy and their discharge
planning and their expertise?
No,
it's because we work in payer-centered
healthcare, right?
It's not patient-centered,
it's payer-centered care.
And so when the case managers go and
they have to actually find a discharge
plan for this patient,
and we've narrowed it down to this one
thing,
that patient may not have access to that,
right?
So by changing it to a more general
recommendation,
our case managers may actually be able to
get the patient some level of care.
So I think it's
Instead of fighting that system,
we're accommodating to that system.
And I think that's the frustrating part.
And I think therapists who are also
accommodating to that, right?
And that's top of facility.
Like you're just doing what you're told at
the place where you work.
It does not lessen your expertise.
But when you think about who is really
taking away your autonomy and authority,
it's really the healthcare system around
us.
It's payer-centered care.
It's not that hospitals don't value your
expertise.
This is also a situation where if you
go back at this person like a keyboard
cowboy and you're like, you're wrong.
All you're going to do is bark at
each other like two dogs through a fence.
This person is talking from emotion.
So if we come back with logic,
we miss.
If we're like, but you're wrong.
The person, I'm going to defend them.
They're not wrong because they're talking
about how they feel.
Yeah, and it's been their experience.
And it's their experience.
And I've consulted with enough hospitals
to know that that's not a unique
experience right and there is also this
conversation too like in in acute care
settings are you an interventionalist are
you a consultant are you a discharge
consultant or are you an interventionalist
and i think there's space for both right
and i think hospitals might also benefit
from dividing their teams and these are
the people that make discharge
recommendations and these are the people
that intervene on the patients that can't
discharge
And maybe you are a little more effective
that way.
And people get to do what they want
a little bit more,
but I don't think anybody went to PT
school to become a discharge monkey and
tell people like, I,
I am going to say this patient can
discharge or not.
Like, that's not,
I would say that's not the dream.
Right.
Of course not.
I mean, maybe for some people.
I mean, I don't know.
Some people.
But I would say a majority.
Like in the middle of the bell curve,
the answer is no.
What would you say to this person if
they were like in front of you?
I think your first move would be you'd
wait to let them get all the air
out and get all their...
That's the smart move, right?
But after the person did that,
what would a conversation like this person
and you look like?
I think the first question that I would
ask, obviously,
is just like receiving a patient history.
I would say, tell me, like,
tell me all about it.
Tell me about your experience so I can
understand what your experience is,
both in the acute care setting and the
emergency department setting.
And then once, as you said,
they like let all the air out and
they feel like they've really been heard
because they think that's the thing.
This person clearly doesn't feel heard,
valued, or respected for their expertise.
I would ask them,
what do you want it to look like?
What changed?
What would you like, like,
what would success look like for you in
your current role?
And what does it look like?
Because right now they would describe it
as discharge monkey, which is valid.
It sounds like I'm being like real
woo-woo, but I'm not.
I'm just like, okay,
to get this person to see something
differently, potentially,
I have to try to understand what they
think they're seeing.
Because whatever they think they're
seeing, they are seeing.
Most likely, you and I both know this,
it's the system they're in.
We can be mad at a system,
but then recognize the system's just made
up of a bunch of people who are
all in constraints.
And they might not have a lot of
like, well,
I want to blow up the system and
change it.
It's like the system is people.
We're going to all come back together.
I understand.
But the system is also massive and
interconnected.
I'm not saying it can't be done.
I know it should be done.
But that stops so many conversations.
This is not a great social media strategy
is when someone comments on one of my
videos.
Well,
then they need to lower tuition costs.
And I was like,
who are they and how will they accomplish
this by yelling at schools?
What do they do?
Stand outside the school like from the
movie,
say anything with a boombox and just stand
there until it changes.
No, it's not going to work.
What would you do?
This is when other organizations go,
APTA doesn't do it right.
I go, how would you do it?
I would just accomplish it.
Great.
How would you do that?
No answer.
I would just make them with what?
A gun?
What would you do?
What would you do realistically?
And the answer is they don't know.
I love when people do lobbying.
Like I would love to have just,
I've talked to Justin Alley before.
I would love,
he would never be able to answer my
questions.
He shouldn't.
As a media professional, I'll be like,
Justin, do not answer my questions.
Because I would love to hear what people
yell at him.
Like, why don't you just do this?
And he's like, he's probably thinking,
I freaking do do that.
Me and a team of people who this
is our freaking job and we've been doing
it for decades.
We do that.
or they're like why don't you do this
you're like that doesn't that's not the
way it works like that's like me yelling
at my auto mechanic to blah blah blah
it's like that ain't the way it works
numb nuts and it's funny that you
mentioned that i was interviewed for
research studies today about prescriptive
authority for physical therapists for
imaging labs or imaging image labs and
durable medical equipment and one of the
questions they asked me were like how did
you get that authority and what were the
barriers that you had and how did you
overcome those barriers
And I was like, well,
let me tell you.
I was a member of the APTA.
I became the APTA president.
Advocacy, working with our lobbyists,
testifying with many, many, many,
many steps.
I didn't stand there and say,
physical therapists should have this,
and that's that, or be mad about it.
So it was interesting to actually have to
explain that.
But I think for somebody like this,
the place that I would start with that
is,
are you behaving like a discharge monkey?
Okay, great.
So step one is,
what does a discharge monkey mean?
Help me understand.
Yes,
and you can control what you can control,
right?
Correct.
And I talk about top of license,
top of facility, and top of scope,
and that we have limitations at every
single one of those layers.
But for this patient,
let's say they're not able or willing to
do anything at the licensure level or even
at the facility level.
They still have their own scope, right?
When you walk into a room,
in the acute care setting,
are you walking in there bringing
discharge monkey energy,
or are you bringing comprehensive doctor
of physical therapy,
patient management energy into that room?
It may be, you know,
they may be telling you,
you have to see this many patients a
day.
We really need discharge recommendations.
That's our focus here and that's okay.
But how are you interacting and engaging
with that patient?
You can still be the discharge monkey and
add value to that patient encounter.
Yeah, I mean,
I've got experience outside PT.
It's where most of my career was.
I could have done the exact same things
that I did to,
and I'm using air quotes here,
be innovative and be energetic and bring
good energy.
And I could have had a crappy boss
and I would have never gotten promoted.
I would have been dumped on,
not allowed to do things.
And I would have been the same person
in a different system and got crappy
results.
And then I would have been jaded and
said, the system sucks.
I think I lucked out.
this person might be or might have been
a very optimistic, energetic,
let's go change the world in a good
way, however I can.
And if you're in a system where someone
just, I mean, let's be honest,
like if you got a crappy boss or
you're in a crappy system with no
rigidity, I've worked in hospital systems,
in communications.
And I came in there ready to change
the world.
I was like,
look at all these great things that happen
at a hospital.
This is going to be the easiest and
greatest job in the world.
All I have to do is tell stories
of great people doing great things every
day.
And then I got slapped with so many
rules and constraints that someone like
me, I was like, I can't do this.
It takes me forty nine steps to tell
one story on Facebook.
I'm out.
I got that way.
But I recognize it was the system.
I'm like, I just can't operate here.
I got to go somewhere else.
Well, and that's the thing.
So people will come to me and they'll
say, well,
I really want to practice the top of
my scope, but they will let me.
So we have that conversation, right?
Who is they?
Why won't they let you?
And what can you do about it?
And you can advocate for change within
your facility.
You can advocate for change within your
license,
but you can also advocate for change
within yourself.
And if you're not able to bring that
expertise, that authority,
that energy that you want to the place
that you work,
You're making the choice to do that every
day.
Like bottom line.
I mean, that's what you can control.
And, and I, I know that we,
it's more nuanced than that.
I know we have golden handcuffs.
I know we have to pay off our
debt.
We have children to support.
Like I have three kids.
I understand that.
But I also know that I've chosen different
paths so that I can
feel comfortable about what I'm doing so I
can advocate for the change and still meet
those goals.
And I know not everyone has the freedom
to do that.
Yes.
So if you don't, I totally respect that.
But who are you showing up as?
Don't let them take that from you.
That should be the one thing you try
to hold on to.
I mean, I had bad bosses.
I had bosses who stole my ideas.
I had bosses who just wouldn't let me
do anything.
And I was just like, okay.
I looked, I stole a line from Mr.
Rogers was like,
that whole line where he says,
look for the helpers.
He was teaching kids how not to be
traumatized in a crazy event.
He was like, just focus on the positive.
So I would look and they're there.
They're the ones that make eye contact
with you in a meeting when you brought
a good idea or a good idea is
said and watch them,
even if they don't nod because maybe they
can't.
Their eyebrows go up and they start
looking around the room going,
who are the...
Alan Jetty taught me a term.
Is Alan Jetty still the editor of PTJ?
He was.
I haven't.
Anyway, he taught me this phrase.
He gave a talk.
It was called positive deviance.
Yes.
So a lot of times people...
If I were to describe myself as a
deviant, that sounds negative.
But deviant just means to deviate.
I know it's used a lot of times.
Kids are just deviants.
They're down there with the skateboards
and whatever.
It's looked as negative.
But when you put that word positive in
front of it...
Um, it's like,
I'm here to shake things up because I
want the same things you do,
but I have to hold up a mirror
a lot of times in projects and meetings
to people and be like,
you're telling me to do it the same
way and expecting a different outcome.
And we know that's the cliche of cliches.
Yeah.
So how can we do it differently?
And I can give you ten ideas knowing
we can only do one.
That's okay.
I'm the idea machine.
You help me pick and then we'll execute.
And the problem is sometimes the machine
doesn't want to change.
Sometimes it's too big.
Or it doesn't know how.
That's what I look at myself or I
try to be the idea to change Sherpa.
Which is like,
I don't know the way but I know
that there's
I just steal.
Like, look, look what they did.
Look what they did.
Could we steal the elements of that that
made that successful?
Hold on.
Like, I know like in PT school,
everybody loved case studies.
They're great, right?
Because they're real.
And like,
look at the elements of a case study.
A thirty nine year old woman like, oh,
I can I can see that.
OK.
And she does this and she lives.
I loved case study because there are many
stories.
Right.
I love case studies in marketing and
communications and ideas and ideation and
innovation because it's like,
I know we're not Yahoo or Netflix or
Amazon, but you can be like,
they were faced.
I learned one today.
I'll teach it to you.
This was a while ago.
This was years ago.
Netflix was getting a lot of complaints
early on.
They used to be, kids,
they used to be a DVD mail service.
So DVDs were like videos on discs,
on coasters.
When they went to All Streaming,
They were the first streaming platform.
You use a remote control to go on
the internet on your TV and watch things.
And they were receiving their number one
complaint was not what movies they had or
didn't have or any of those things.
It was, you're buffering a lot.
I'm in the middle of a movie and
it's grainy or it buffers.
And Netflix could have done a national ad
campaign saying,
We don't control your internet speed.
It's buffering because Spectrum or Optum
or all the different, wherever you live,
they're lying to you.
When you say you're buying your plan at
however many gigabytes per minute
download, whatever,
I don't even know what good is.
That isn't the actual speed.
They could have done this education
campaign where they just pointed and
placed, they moved the blame.
They didn't do that.
Somebody in the room was like,
it's not going to work.
Great.
What should we do?
They launched a website called,
I think it was called fast.com.
And it's similar to like internet speed
test.com.
Have you ever done internet speed
test.com?
It's just a way of actually measuring your
speed right now in this moment, upload,
download speed.
So they were like, hey, test this out.
And then when you got the data,
like this was your speed,
this is what you need to actually stream
a movie reliably without problems we don't
offer the streaming so that's okay like
they were bringing people to like the two
yard line going who's problem who is
actually the person screwing you over on
watching this movie we're giving you the
access you need the person who's bringing
you here is the internet service provider
the isp
So it was a great power play.
So my example is like, oh,
if we're getting a lot of complaints,
let's look at people who solved complaints
innovatively.
And I think when you're this person and
you are probably objectively pretty burnt
out and kind of given up on things,
I think you're lacking that feeling of
power,
that lack of
the agency, the control.
And probably there's some moral injury
that goes with that too.
Because you're not being who you want to
be.
Yeah, that sucks.
That's not the person that's probably
going to solve that.
But I read a quote this morning that
was like,
excellence in healthcare comes at a cost.
Pay it anyways.
What we give doesn't always return,
but what we give is always what we
are.
And that's like the kind of therapist that
I want to be.
So that's why I feel like
when you go into that room whether you're
tasked with being a discharge monkey or
not do you bring that energy with you
or are you bringing the physical therapist
energy with you yeah like you can be
angry you can be angry about it but
are you taking that anger out on your
patients yeah right right right right
don't become the thing that don't become
the thing that you're raging against
Rage against the machine didn't say rage
against the machine,
then become a machine.
It said rage against it.
But like, what are the different ways?
It's not throw a brick.
And even just like that little act of
resistance where you're bringing the best
you can into every room,
even if you don't have the energy,
if you don't have the skill set,
you don't have the knowledge of how to
advocate within your facility,
within your profession, within your state,
at the national level,
please like advocate within yourself.
Yeah.
It's going to be frustrating too,
because I'm sure like in your role,
you've been with, you've been, I mean,
now you're APTA Colorado president,
but you've done other things.
Right.
And when you get a bunch of really
motivated, passionate people together,
who want to do fifty different things a
hundred different ways knowing that you
can't there are constraints there is
bandwidth so you know which problem do you
just I mean even deciding which problem to
solve is a problem because you're going to
make more enemies than friends I used to
hate doing contests on the radio here's
why
Most of our audience,
most of the listeners didn't participate
for whatever reason.
They're busy.
We surveyed people this.
A lot of times they were like,
mathematically, I'm not an idiot.
I'm not going to win.
So you're going to ask me to try
something.
I'm not going to win.
I get it.
I was the same way.
I didn't always try to actively
participate in contests.
I mean, I did win one once.
What'd you win?
I won a signed copy of the Ray
soundtrack.
Remember that movie with Jamie Foxx?
I won that and I won tickets to
Evanescence.
So I won twice, I guess.
I used to love taking phone calls because
the phone calls were great payoff, right?
Always record the phone call as a radio
DJ and then play it back because it's
great energy.
The person's happy, right?
And I used to love,
but one of my schticks was because I
heard it enough.
People were like,
Oh my God, I can't believe I won.
I never won things.
And I was like, I would be like,
Rebecca, Rebecca.
And like, yeah,
like you can never say that again ever.
Cause you won one thing for the rest
of your life.
Like play with it.
Right.
I always,
I would also have fun with it.
I would push back.
So of course we would like Pavlovian dog,
have a sound effect, be colored X,
be color tan right now.
Right.
And people would call, Hey,
This is the radio station.
Who's this?
Rebecca.
Did I win?
I would twist it.
I'd be like, what are you calling for?
And if you didn't know what the contest
was, I clung up on you.
And that pissed off one person.
But I made a hundred friends because they
were like, good.
I really wanted that.
And I didn't win it.
And I don't want her to have it
because she didn't even know what it was.
So that is the way,
because I just said,
I didn't like doing contests because in
contests,
you make one friend and ninety nine people
get pissed.
That math don't math.
But I did.
I twisted it.
And I was like, no,
you don't get it because you don't know
what it was.
You were caller ten and you can take
this up with our lawyers.
No one did.
But I would have fun with it.
I would also say,
I'm going to ask for caller ten.
You better know what you're trying to win.
Just tell me.
You don't have to be like, exactly.
You're just like, oh,
the tickets for the evidence.
Got it.
Yeah, you pay attention.
But if you didn't, I push back.
That was a way of like me sort
of combating the people listening going,
I never win.
They were okay with not winning as long
as someone who in their eyes didn't
deserve it didn't win either.
Sometimes you win by losing.
So whose job is it to talk to
this guy at a hospital and be like,
hey, man, tomorrow you're not working.
We're going to pay you.
You're coming to work.
We're going to go hang out.
And I need to listen to you and
figure out how to get you back on
our team.
Is there a job for that?
What job is that?
I want that job.
Well,
I think that I would love that job.
I wish I could be a guidance counselor
for physical therapists.
Guidance counselors for companies.
Yeah.
Isn't that a job?
I mean, HR, isn't that HR?
I don't think so.
Cause I think HR is all defense, right?
They just work for the company.
It's like defense and procedure, right?
Like, I don't know that it's investment.
Like there has to be like a human
assets department,
like a development department.
Like, and I think,
I think then you get into that like
rabbit hole of management or leadership,
right?
you have a management team or do you
have a leadership team right totally
different and i think unfortunately the
way most companies i don't just even want
to throw hospitals under the bus most
companies are set up to have supervisors
and managers not like leaders and leaders
also don't necessarily make good managers
right so i feel like you have to
have some combination of both but i feel
like this is where your leadership
maybe not your managers,
have to step in and help lead people
through.
But I don't think there is a job
for that.
I think that the organization would have
to be big enough to financially afford
that and then allow that person to...
Invest in people.
Did you ever hear of a story from
Zappos?
You know what Zappos is, right?
It's like an online shoe store.
And people were...
People were like, to Jeff Bezos,
when he launched Amazon,
when he was just going to sell books,
they were like,
that is the dumbest idea ever.
Who's going to buy a book online?
And then you go to like, I know,
me too.
And then you go to shoes and people
are like, you have to try shoes on.
You have to walk around.
Do you remember before the first day of
school,
how important it was to try it on?
And your mom was like,
walk around in it.
And then everyone's like watching you walk
around.
You're like, yeah, they're new shoes.
Yeah.
I don't know.
Like, what am I supposed to feel?
Anyway, I digress.
So then someone launches Zappos.com and
they're like,
that's not going to work because shoes are
all about touching the shoes and putting
them on and feeling them.
They had a problem with complaints.
And the guy who launched Zappos was one
guy.
And then it was two people.
And then it was
All complaints went through this guy.
Someone's going to Google the name of the
CEO or whatever who came up with it.
The Jeff Bezos of Zappos.
And he realized he was handling every
complaint because in his mind,
he was like,
I want to touch every complaint.
Good idea, but...
bad execution because there were so many.
You're an online retailer.
And then the longer someone's complaint
takes to get solved,
the more pissed they are.
You can't blame them, right?
It's like an ounce of prevention,
pound of cure.
But that ounce of prevention needed to
come in the first
And I forget the exact dollar amount,
but it was like,
if you're taking the complaint,
if you're John Smith on the phone at
Zappos,
And it's your complaint to handle.
And the solution to make this person happy
is less than two hundred dollars.
Just solve it.
Just do it.
Just write in the computer.
This guy had a legit complaint.
It was this and this.
And I just gave him a two hundred
dollar credit.
And the guy was thrilled.
And he was like, the time it took.
was worth just solving it.
Yeah.
That's why like sometimes if you order
like furniture is a big one.
If you order something with furniture...
And there's a problem with it.
And you can prove it with a picture.
And this is where also people start
scamming the system.
But a lot of times,
they'll just be like, keep it.
We'll send you a new one.
And now you have a slightly damaged
whatever.
That's why you see them on Facebook.
My buddy,
you see them on Facebook Marketplace a
lot.
Because people are like, I don't know.
Wayfair sent me a hot...
My buddy's neighbor bought a nine thousand
dollar hot tub or something crazy on
Wayfair.
And there was a giant scratch in it.
And no offense, but like...
I dropped nine grand.
I want the version without the scratch in
it.
Right.
So they were like,
we'll send you a new one.
And he's like,
what do I do with the old one?
They're like, it's your problem now.
He gave it to my buddy.
He was like, do you want this?
And my buddy was like, yes.
And he's like, there's a scratch in it.
And he goes, I don't care.
But somewhere along the line,
someone did the math and was like,
I need that guy to be happy because
that guy's,
if he's dropping nine grand on a hot
tub,
his lifetime value of products is more
than nine grand.
Make him happy.
How much does it cost to ship the
first one back?
Ship a new one.
We already had to ship the second one.
What do we do with the first one?
And then we ship it back?
What are we going to do with it?
I need to warehouse that.
Now it's going to sit here.
Now it's damaged.
It's like, dude, deal with it.
Well,
and I think one thing that you point
out really well and often,
especially about communications,
is that nobody owns it.
Nobody owns that.
And I think that's the same problem with
this therapist, right?
Like,
the people making the decisions about how
they will implement and utilize physical
therapists are not taking any
responsibility for that impact on that
therapist, on how that impacts them,
on how that impacts morale,
because their job is not to advance
physical therapy.
Their job is to advance the mission of
the hospital in the healthcare context
that it exists in.
So there isn't anybody who is responsible
for making sure that their therapists are
feeling like
They're well utilized,
that they're competent and taken care of
and practicing at the top of their scope.
Like no one owns that.
So when you say whose job is that?
Nobody's.
There's a hole there.
And it's going to be a very expensive
hole for a shortage.
Good.
But Rebecca,
hiring someone just for that job?
How will they ever meet their
productivity?
Well, not even that.
Like we're going to pay someone to do
this job that should just not be a
problem.
Sorry, it is.
And then we can't pay for that.
I would push back and go, you are.
It's just hidden in your P&L.
And it's because you hired someone and
they stuck around for two years and left.
And now you had a vacancy for a
year and you didn't fill it.
And now you burn the rest of your
staff out because they had to fill in
because that's what people with a Peace
Corps gene do.
And we appreciate that.
So we take advantage of it.
You're paying for it,
whether you're doing it or not.
Well, statistically,
presenteeism is worse than absenteeism.
Wait, what is presenteeism?
Presenteeism,
you might have to look up the exact
definition.
I learned this from a course that I
took with Mike Eisenhardt.
Presenteeism is that person that shows up
to work every day with that attitude.
Which with, with which attitude?
Like the discharge monkey attitude.
It doesn't matter.
Like that, that person,
the person who's like present,
but pulling everybody down with them.
They're like the vacuum in the room.
The person's going to ruin it.
Even if their stats,
even if like their output was great,
they're net negative by a lot.
Cause they're going to make a lot of
good people leave.
And you would rather have that person not
come to work.
Yeah.
Work every day and be this like net
drag.
Right.
So they found that people who go to
work like that just they just drain the
system.
And so if you're looking at like physical
there to work with,
like direct to employer type services will
focus on those folks.
Right.
They'll focus on the absentee folks too,
right?
Like, is that a health condition?
But they're going to focus on all of
those people to help bring them back to
the pack, right?
And make sure that everybody's attitude is
better.
But do you work on keeping everybody happy
or do you have to focus on those
people that are really causing the
problem?
Are you a hockey fan or are you
a baseball fan?
Are you a hockey fan at all?
I'm a baseball fan.
All right,
so there is a stat for this in
baseball.
It's called WAR, W-A-R,
Wins Above Replacement.
I'm a baseball fan too,
and I can't understand WAR.
The idea is, as a right fielder,
how are you compared to other right
fielders?
When you're in the game,
do you do the intangibles well that never
before showed up on the stat sheet?
It's a little easier to explain in hockey.
Even not a hockey fan, you'll get this.
So how do you get things in the
back of your hockey card?
Goals, assists, penalty minutes,
time on the ice, how much you work.
Those are easier to measure, right?
Then they come up with this statistic
called plus-minus.
So let's say I'm on the ice and
I actually...
So the way to get an assist is
I pass it to you and you score.
I get an assist.
Another way would be I pass it to
Steve.
Steve passes it to you.
You get a goal.
Steve gets an assist.
I get an assist.
But there's a lot of stuff going on
on a hockey rink
That isn't just that.
Like maybe I needed to dig the puck
out of the corner of my own zone,
then pass it to Steve, then Mike,
then Rebecca.
She scores.
I got nothing on that.
That's okay, but that's a thing.
Or the guy who is always really good
at communicating.
But how do you put that on a
stat sheet?
So they came up with plus minus,
which is when a goal is scored,
the person in the booth and stats just
writes everybody's name down who was on
the ice.
And that's a plus one.
When a goal is scored against us,
who is on the ice?
That's a minus one.
And just like a running count,
if you're card counting in blackjack,
what's the running count on Jimmy?
Yeah.
Man, every time Jimmy steps on the ice,
we get scored on.
But we don't measure that because...
I didn't get a goal.
The goalie gets a goal against her or
him because they're the goalie,
but I'm just a forward.
But it is my responsibility to guard my
guy.
And when I'm out there,
I just sort of don't.
And then that leads to a pass,
which leads to a goal.
So the answer was plus minus.
So you want to be as plus as
possible,
which is like we get scored on as
little as possible.
We score as much as possible.
It's an imperfect way of measuring the
intangibles.
That's hard to do in business.
It is.
Where would you do that?
That's not a net promoter score.
It's not NPS.
I also would love to see outcomes for
people who feel like that,
for those therapists who are really burned
out and aren't bringing that energy into
the room with them.
Are you delaying people's discharge
because you're not intervening the way
that you should?
Are your patients more hesitant to go home
because they're
Your attitude does not inspire confidence.
Do your patients need home health more
often?
Are the home health therapists like,
why is this patient in this bad of
shape coming home?
Are you discharging more people to rehab
than home with an assistive device?
What do your outcomes look like compared
to people who are operating
positively within their scope as opposed
to walking into every room being like i'm
just here to just make a trash
recommendation and then leave i mean there
was a guy who had the same job
as me in radio there were four radio
stations in one building all owned by the
same company right and a guy ran a
country station his office was next to
mine and he was sort of an eeyore
So I got told one day on a
Tuesday that I had to go home and
come back the next day and fire someone
from my staff.
Have I told you this story before?
I had to go home, Jimmy.
You have to come home tomorrow,
come back to work tomorrow.
And my boss was like,
tell me who to fire.
It's your job.
You're the boss.
You get to get handed the trophies when
you win.
And then you got to do the bad
work.
So I went home,
had a couple of Chardonnays because I was
pissed.
None of my people did anything wrong.
They were all on the plus side and
the plus minus.
They were hard work.
But I had to fire one of them
because numbers.
And that's a reality.
So I went home and I thought about
it similarly to how we're thinking about
this.
But I didn't think about it from my...
particular small radio stations point of
view.
I thought about it from the entire
building.
So four radio stations.
And I was like,
this guy over here is a,
this he's a net negative guy.
And he makes more money than my people.
And the station he's running isn't
performing well because of, I mean,
my extrapolation because of his attitude,
this guy could, you know,
so I went back in the next morning,
a little hungover and I said, Hey boss,
I got a crazy idea.
And he was used to me saying that.
And he's like, Jimmy,
this is not the time for a crazy
idea.
This is the time for an,
I need an answer, dude.
And I was like,
I have an answer that is going to
give you an answer that
You're going to save more money and you're
going to give me a raise.
And he was like, oh,
I can't wait to hear this.
And I was like,
and I just made my case.
I'm like,
you got a guy over here running an
entire radio station.
And we both know
He ain't going to get it done.
And it's nothing he's doing.
It's who he is.
He's an Eeyore.
And you can't out Eeyore this guy.
And I was like,
you're going to fire him.
I'm going to take over his radio station.
This was a country radio station.
I knew nothing about country.
And I said that, Bill, you know me.
I'm a rock guy.
I know nothing about country.
He goes, yeah.
How are you going to get around that?
There's a staff on that radio station that
knows all about country.
I know how to work with people and
be creative.
I also know how to listen to people.
So I'm going to do that guy's job.
You're going to save money because you're
going to hire,
you're going to fire another manager.
You asked me to follow, you know,
fire one of my people.
He makes more money than them.
You're going to give me a little bit
of that money because now I'm going to
do two jobs and net positive, we will,
the team will be stronger for it.
You're going to fire a good person and
let a net negative person,
what do you call them again?
Like a...
presentism you let that person stick
around and when i made the case he
was like you're right by five o'clock that
day i was running two radio stations and
someone was like sorry but i protected my
people they did nothing wrong they were
all plus plus minus people and you were
a minus plus minus person and i want
plus plus minus people and we would have
been net negative if i hadn't pulled that
move and i will do it ten times
out of ten that's how i got my
second radio station
And I think,
I think the question that people are
probably asking if they are in management
is how do I screen for those people
to keep them onto our team?
How do I avoid the conversion from a
positive to a negative?
Because I think that's a big one.
Yeah.
Cause everybody, yeah.
No one shows up to be that right.
And it does happen and it happens a
lot and I see it and I see
it everywhere in our profession, right?
You just have to look at social media
comments.
Like,
i tell people not to become a physical
therapist because of x y like you're
poisoning the well before they even got in
the water right like why are we not
making the profession better why are we
just like i think what they're with i
mean they're i mean a psychologist would
say they're projecting right yeah and i've
made videos i will not talk out of
both sides of my mouth i am pissed
off at the math because math don't care
about vibes totally
So I would like to change the system
as well.
But yes, I agree with that.
I mean,
I put a comment every day that got...
Someone asked about, should I become a PT?
And I was like, do the math.
If you really want to do this and
you understand what it costs and you still
go with it, great.
Go with God.
Knock yourself out.
But like someone said,
schools should do a better job educating.
And I'm like, my man,
they gave you the papers.
All the numbers were in there.
You're not looking at them as your fault.
So I'm not saying don't pay back the
loans or any of those things.
I'm saying let's change that because this
sucks.
And down the line,
we're going to have less good people on
our team.
And that's going to screw everybody.
So I'm not saying let's just erase it
and say, ah, you made a bad move.
Let's change the whole damn thing because
it's not good.
Never mind fair or equitable.
It's deeper.
It's not good for the system,
for the person, for the people,
for the organization.
It's not good.
So if something's not good,
I thought we were supposed to be able
to change it.
And here's the problem.
The parts of the system that make the
decisions for not good, I'll talk to them.
They're not listening to my podcast.
I could talk about them for months.
The people who decide what PT programs
cost, from my understanding,
I talk to people.
It's not the professors, guys.
Trust me.
They are not rolling in cash.
I'm not saying they're not making money.
They should be.
They have a ton of experience and do
a great job.
It is not the chairs of the department.
It is not the deans.
people you've never met who are doing jobs
that you have no idea.
It's those people.
They're not listening to you.
They're not.
That's probably their problem,
but they are not incentivized to make you
happy.
They win the minute you apply and sign
and someone gets paid.
So how to fix it?
I'm not saying I know how,
but you're yelling at the wrong person.
You're mad at the wrong people.
It's also like saying that the APTA is
somehow like in a hundred percent control
of what we get paid.
Correct.
I'm not saying you're not.
You're yawning at the wrong people.
Like they're doing the things,
but you need to take all that energy
and take it to where those decisions are
made.
And then talk is doing that.
Right.
And then talk to them in a language
that they can understand.
Listen, they know what they're doing.
Right.
They know what they're doing.
There's just no reason for them not to
do it.
Oh, we should stop applying.
And I go, would you have stopped applying?
No.
You wouldn't have.
It will not change until the pain of
inaction is greater than the pain of
action.
Did I do that right?
Yeah.
The pain of inaction is greater than.
That's the only reason you get off the
couch because you feel an internal pain
that staying here hurts more than what it
does when I just got to go run
a couple of miles.
There's no reason for them to lower costs.
This whole thing with the unprofessional
Malone's thing,
it's not going to change it.
Not going to change cost.
It will screw people because they won't be
able to...
It'll change who is able to apply from
the smart people that I've talked to.
I would love when people are in my
DMs going, but, but, but...
If there are forty seats at a program,
as long as there's forty-one qualified
applicants...
Ta-da!
There's no change.
You need to have six applicants at most
for five years before it would change.
And I'm making up numbers,
but you get what I mean.
You need to be bleeding before you call
the ambulance.
It's not going to happen.
It's just like PT payment, right?
PTs have been taking the payment the way
that it is for so long.
Why on earth would insurance companies
suddenly be like, you know what?
We were wrong.
Correct.
Let's pay you more money.
The other way too, hey,
we're taking jobs at salaries we shouldn't
do.
And you're saying we should unionize.
And I'm going, great.
Are you any good at organizing people?
Yeah.
I'm not saying don't do it.
I'm saying the likelihood of that
happening is low.
Yes.
I would love to be wrong here though.
I would love to be.
Maybe that is the only way.
I don't know it.
But being mad at the wrong people,
it's a real waste of energy.
I don't blame them.
I don't either.
I don't blame them.
We're measuring the wrong things.
I don't know.
It's easier to be wrong or being angry
at a group of people or a perceived
person in the entire system because if
you're mad at the system,
it feels too big to solve.
Who gets yelled at when you don't like
what a PT program is doing?
The chair and the professors.
They are not the ones setting the prices.
My friends, if they were,
they'd be setting their own salaries and
trust me, they'd be higher.
Like it's just not, it's not it.
You're not wrong for being mad.
You're just yelling at the wrong thing.
In my opinion,
this is just everything here is my
opinion.
All right.
So to make this tactical,
let's say you did work for this person
that we started this whole conversation
around with.
You work and you are in a position
of leadership, not management,
but management and or let's say
leadership.
What would you do?
I would want to hear everything.
Say it.
Like, no holds barred.
Like,
this will not reflect poorly on you on
your performance evaluation.
This will not be held against you.
Like, tell me everything.
Tell me.
Like, lay it on me.
I even want to hear your personal stuff,
too.
Because maybe this person is under a lot
of personal duress as well.
Like, they have a health problem.
They aren't making enough money for their
family.
They've had to pick up a second job.
Like, I want to hear all of it.
I want to hear why they wanted to
be a PT.
I want to hear why they're still a
PT.
I want to know why they feel the
way they feel.
And I just want to receive all that.
I think that's step one, right?
Just receiving all of it,
not telling them, not explaining,
not defending.
Well,
the hospital had to make this decision
because I was like,
we're not doing that today.
We're just receiving all of that.
What do you love about this job?
I want to hear all of that too.
Like, why did you take this job?
Why are you still at this job?
What would make this job feel worth it
to you again?
And then like that stretch goal too,
like what would make this job magical to
you?
Like what would make this job someplace
that you wanted to be every day?
And if you can't see a path to
that, like if there's like nothing,
if you're, if your answer is nothing,
it's never going to be like, I don't.
Then maybe we just be done.
Maybe it's time for you to look for
something else.
Like,
because I'm fully receptive to hearing
from you,
like what it would take to get you
back on the horse.
I want to get you back on the
unicorn, but.
If you can't see a path to that,
I can't even meet you halfway.
So I'm probably going to decrease my
investment in you because you've decreased
your investment in the organization.
And realistically,
if you're bringing that energy into rooms,
you've decreased your investment in your
patients.
And maybe at this point,
you're a little bit of a liability.
I don't know that for sure.
I'm not like if I felt like I
was in the hole that deeply,
I would be worried about my ability to
provide care.
Yeah.
So I would start there.
Oprah said people want to be seen, heard,
and understood.
Yes.
That's where I would start.
And if there's the movie Jersey up in
the air with George Clooney and Anna
Kendrick.
Yeah.
Where they fire everybody.
Well,
their job is to be brought in and
he had the one who's the guy from
the drumming movie.
Um,
the guy that was in Top Gun too.
No, J.K.
Simmons, the drumming instructor.
Yeah.
Not Miles Teller.
So anyway,
George Clooney is firing Miles Teller in
this scene.
It's a great scene.
And of course, like J.K.,
is pissed his character jk simmons
characters piss and he's like who are you
you know f you and clooney and of
course it's a movie guys i get it
but he turns it into a story he
read that guy's whole file before he
brought him in to fire him whole file
and jk simmons is in his fifties or
sixties or whatever in this scene and he's
essentially he's framing this as like a
rebirth and he's like
The whole pitch is he saw in the
guy's file that he studied French culinary
arts in college.
Like, that's not a gimme major.
Like, that's hard.
And, like,
you're not going to make a billion dollars
doing that, right?
So he's like, and he's like,
and you waited tables at El Picador.
Like, he read the guy's file.
And now he's in, like, some cubicle.
And he's like, and his question was,
how much did they pay you to give
up on your dream?
Ooh.
And he was like,
thirty eight thousand dollars in health
insurance.
And he's like, I'm not he's like,
this is happening.
But he's like,
your next step is your choice to make.
And you lose your job.
It's not softening the blow,
but at least it's at least saying like
you could go find another one of these
jobs and this could happen again.
And also you hate it here.
Why aren't you in a kitchen?
You wanted to be in that kitchen.
And you made the smart move of getting
a reliable job with four Oh one K
and health insurance.
I get it.
But he made the guy look at himself.
Cause you could be mad at the company
or the machine or the world.
And that isn't going to change it.
But you reframing how you're going to look
at it is the only, it sucks.
You can control what you can control,
but you can control it.
So that was a great,
I thought a great scene from that movie.
Cause at least Clooney's character was
like,
Can you imagine?
I couldn't do that job.
The guy where you just fire everybody.
Although someone's going to do it.
Someone's going to do it.
It's happened.
That was one of the lines.
This is happening.
But it showed he actually took the time
because people want to be seen, heard,
and understood,
according to our friend Oprah.
That's probably why she was pretty
successful.
To do that with that guy and the
idea there is his character is now going
to leave and
inhale exhale while he takes his stuff to
his car in a cardboard box and go
what do i got twenty more years man
what do i want to do go do
that yeah go do that all right parting
shots what do you got parting shots i
think my parting shot is is to this
therapist and in any therapist that feels
like this we don't want to lose you
like so
Figure out what it would take for you
to get back on the unicorn.
And if PT is not it,
I get that.
If it's the place where you work,
I get that.
But advocate within yourself,
advocate within your facility and advocate
within your profession.
And if that feels like too much,
then let it go.
But we want you.
We want you in this profession.
And so do the best that you can.
Control what you can control,
which is what you bring to your job,
what you bring to your patients every day.
If I repeat it a couple times,
it probably has to be a parting shot,
which is people want to be seen, heard,
and understood.
I ain't magic.
When I was a boss in radio,
I didn't have a lot of levers I
could pull.
But I learned from my dad,
who was a fireman.
He was like, when you get promoted,
you work for them.
You work for the people you oversee.
So my job was like, how are you?
And I can't be like,
here's a bucket load more money.
That wasn't an option.
So how else can we creatively make this
place something that you want to do again?
Because supposedly when you came here to
work, you wanted to do this.
So people want to be seen, heard,
and understood.
Find Rebecca online, website.
BDDPT.com.
And we'll talk again soon.
I think we need an actual official name
for your recurring segment.
I don't want to use AI to get
it.
I want it to be au natural.
Maybe,
but I will take comments or suggestions
from someone watching or listening,
but we'll be back next week with Rebecca.
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.
See, Keith?
We read the script.
Happy now?