Broadcasting way too early from three
separate Wi-Fi connections.
It's PT Breakfast Club with Tony Meritato,
Dave Kittle, and Jimmy McKay.
All right.
Welcome to PT Breakfast Club,
where physical therapists gather twice a
week to talk about business, marketing,
and occasionally realize that the problem
might not be staff.
It might be the system.
I'm Jimmy.
That's Tony.
Dave is somewhere selling cream for knees.
We'll get into that when he comes back
next Tuesday.
He's going to drop his business model.
He's going to start selling stuff for
knees.
We're going to talk about KPIs.
For some reason,
that's been a conversation that several
people on LinkedIn and Twitter,
not Twitter,
LinkedIn and Facebook have been having.
And we sort of wrapped up last week
or not last week.
Sorry, two days ago.
Wow.
St.
Patrick's Day was just two days ago
talking about KPIs.
And then wouldn't you know it
serendipitously,
we got a new sponsor today only.
And here they are.
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Not sure what to track in your clinic?
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Arrival rate, units billed,
smiles per session.
Watch your team optimize for the number
and accidentally destroy everything else.
KPI-o-meter,
because what gets measured gets messed up.
And if that isn't
But that isn't the thing we're sort of
talking about.
Or anyway,
Larry Benz has been writing articles about
this.
He did a whole series on,
I think this is the last episode in
his series.
And he writes online on LinkedIn and he's
got a sub stack called the operator.
And I think it was called something like
to the effect of the metric that like,
doesn't matter.
I'll get the, I'll get the exact,
but it's like,
it's not measuring the thing that you want
it to measure for.
So you sort of wrapped up last,
last live stream on Tuesday with this sort
of idea.
Where do you want to start with this?
Well, you know,
I think we see this in business.
We see it in patient care.
We see it in parenting.
Like parents are obsessed with grades.
Grades don't matter.
I tell my seventh grader all the time,
I'm like,
nobody's going to care if you've got a
C on your history test.
It does not matter.
And I'm not going to be worried that
you're going to be a thirty seven year
old who doesn't understand what the
capital of Arkansas is.
You know, it's just like Little Rock.
So we get these metrics,
we get these ideas in our head,
patient care.
Patients are coming in.
I can only get ninety seven degrees of
knee flexion after my knee replacement.
It's been six weeks.
I don't care.
Can you get off the toilet?
Can you do this is why you had
the knee replacement.
Not so you're a champion goniometric
performer.
And then the same thing in business.
It's like in business.
As the business owner, I'm thinking,
I need patients to complete their plans of
care.
I just heard you and Larry Benz talking
about that in a clip you had.
Completed plans of care.
If the patient does the plan of care,
the patient will get better.
I will make money.
We both win in that situation.
So I think, okay,
I need to improve arrival rate.
I'm going to track arrival rate.
What I don't realize is the person in
charge,
the person responsible for arrival rate,
They're not making the connection that
it's not about arrival rate.
It's about completed plans of care.
It's about success.
It's about achievement.
But the easiest way to manage performance
of arrival rate is to stop scheduling
patients who don't come.
So what we did,
and then I'll give you a chance to
talk years ago, twenty years ago,
we've always worked for a long time.
We've been in network with all payers,
including Medicaid.
Historically,
patients on Medicaid who are relying on
transportation through Medicaid don't have
the best arrival rate numbers.
They just don't.
And so we said,
we don't want to lose these patients.
I might schedule ten visits and get three
that actually happen.
How can I change my system to accommodate
what's going on?
So we wouldn't book a dedicated spot for
an individual that consistently was
missing appointments.
We would give them a flex spot.
Either we'd call them the day of or
we tell them to call us or we'd
put them on the schedule in like a
light gray font so that they might come.
They might not come.
If they come,
we'll treat them and we'll bill for them
if they don't come.
That's OK,
because I've got other patients in that
spot and you can do this in a
compliant way.
But the idea is this allowed us to
not lose sight of what is the actual
goal.
Get patients in the door,
not get the best performance on a KPI
that doesn't really track what we're
trying to achieve.
Yeah.
And this this pops up everywhere in life.
with kids.
I don't even have any kids,
but I've been a kid.
And I'm gonna give you ten dollars a
week for your allowance.
All you have to do is keep your
room clean.
Sounds like.
And the first week,
I go with the letter of the law
and the spirit of the law.
And I keep my room clean.
And then a week in,
I want my ten bucks.
And before mom comes in to inspect,
I just shove everything in the closet.
And I've.
We didn't talk about the closet.
The closet's not clean.
I've heard about surgeons
not wanting to take on difficult cases for
like good surgeons,
not wanting to take on difficult cases
because it might mess up my average.
And if I'm being measured by the average,
I want to do that.
This happens in sales or pipeline
generation.
I've done one of those jobs.
I ever go to do one of those
jobs again, Tony, full permission.
You drive from Ohio to New York and
you slap me clear across the face.
Because once I realized it was a big,
dumb game that didn't mean anything,
I couldn't play it.
I just couldn't do it.
Pipeline generation.
Oh,
how many deals do you think you'll close
in the next three to six months?
And I was like, none.
And people looked at me like a ghast
because I was telling the truth.
How many did I think were closed?
None.
I don't think any of these are legit.
These are all bull.
And yet everybody else was playing the
game.
Like people pulled me aside.
They're like,
you kind of got to make this up
a little bit.
I was like, oh, I'm sorry.
I just thought we were here to do
something.
legit.
So that's where this idea of good hearts
law comes in.
I love these stupid things like the Pareto
principle, eighty, twenty and all those.
And I had heard of this.
Then Larry Benz used it in one of
his articles recently,
which is
uh he uses the the allegory of the
russian nail factory it's a short one
right so russian you're in the nail
factory you're what am i measured with
because i'm working do i work as fast
as possible so they put a metric on
the board produce as many nails as
possible and then you get a bonus that's
even better when you get a bonus so
the russian nail factory the workers were
like all right let's make a bunch of
let's make a bajillion tiny little nails
Great metric hit,
but the nails were so small,
they couldn't use them.
It's like, okay, okay, okay, okay.
We see you game the system.
Let's go the other way.
And said,
we'll do it on based on weight of
nails produced.
That'll be more bigger nails.
So they produced like five gigantic nails
that were useless again.
So metric hit.
So KPIs that we were talking about,
or we were just discussing on LinkedIn
yesterday's cancellation rate.
To sum up what Larry Benz and other
people like Jerry Durham has said is
you're too far downstream with
cancellation rate.
Why are they checked out?
Why would they drop out?
I don't cancel my haircut.
I barely care about my hair.
It's because I need it now.
This is a need.
So I feel like Larry summed it up
well.
Why would someone who is in need and
made an appointment,
why would they cancel?
So are we measuring something way
downstream?
Moneyball, right?
That was the attempt to show where you
could get the right metrics.
It's not about home runs.
The Oakland A's didn't have enough money
to pay for Johnny Damon or, you know,
and Jason Giambi.
So like, well, what matters?
It's getting on base.
So they optimize for getting on base.
It would have been a better story if
they actually won the World Series that
year.
Right.
It would have flipped.
It has already changed baseball,
which is already over metric size.
But they didn't say,
let's not look at metrics.
They said,
why are we looking at these metrics and
not these?
Because these, the goal is to get wins,
wins produce playoffs,
playoffs produce championships.
So I think this is a shakeup.
And I think people resist this because
they're so used to doing it.
And, you know, that was a great example.
Like,
what are therapists obsessed with
continuing education, certifications,
letters after their name?
We pretty well know the thing that makes
the patient better is liking you.
So instead of you worrying about getting a
new certification for a new manual therapy
technique,
why don't you take a course on how
to communicate better,
how to influence friends and whatever?
Win friends and influence people.
Yeah.
Like these are the things.
If I want patients to get better,
I just need to get their butt in
the door.
It almost doesn't matter what they do
after that.
So I don't want to optimize,
make it easier, flexible scheduling,
no penalties.
You're not going to get threatened.
You're not going to get punished because
you missed an appointment, came in late,
came in early, whatever.
And once we start to realize it's not
about the things we think it's about,
it's not about the things that are
important to us.
It's about the simple things that have big
impact.
I think everything changes.
Everything changes.
uh you ever get a speeding ticket tony
i haven't gotten one i mean i'm knock
on wood here i haven't gotten a speeding
ticket a long time but if giving out
tickets curbed speeding we'd be done by
now wouldn't we i feel like we'd just
be like it's the threat of it no
one wants to get the ticket no one
wants to speed but i do want to
get there faster right so we've said i'll
slap you on the wrist well you don't
show up i'll give you i'll give you
a fee
I don't know.
I'm not saying don't do anything.
What I'm saying is that I think a
lot of the smart people who've studied
this, smarter than me,
go further upstream.
They go, why did that person cancel?
What was it?
Larry calls it the cliff.
Have you seen this as well?
He says it happens after usually visit two
or three.
If they cancel,
usually the fall off is after visit two
or three.
And he put it to me very eloquently.
And all of a sudden, I was like,
oh, not even eloquently.
He put it very simply.
The eval is very intense, typically.
We're measuring,
we're asking a lot of questions.
This is about me.
You're asking me and I'm telling you.
Some PTs will like poke fun at the
patient,
like tell me their whole damn life story.
And I'm like, it's because you asked.
And that's good.
You're getting someone's life story.
A lot of times that's like pulling teeth.
And, uh, so the eval is very intensive.
It feels very like, look, I don't know.
They have me doing things and there's a
measuring and it's all about me.
It's about me, me, me for an hour.
And then visit two or three is like,
Hey, how you doing?
Why don't you jump on the bike over
there?
Now it's like, Oh, what happened?
I thought we were, we felt like,
I thought we were, you were my guy.
I was your guy.
What happened there?
So you go through that motion one more
time and you're like,
oh, I got played?
That was just to get the first date?
You feel like you got sold.
And then when you apply for a job,
the hiring manager or that recruiter is
like, oh my God,
tell me all about you.
Oh my God, I'm so interested.
You're going to love it here.
And then you never hear from that person
again.
You're like, where's Katie from HR?
Where's that?
It's like, oh yeah, dude,
she said whatever she had to do because
her metric was applications to contracts
signed.
And then that leaves you feeling
something.
And I think Paul nails it right here
on the comment when he says relationships
equal everything.
So what is it, Tony?
Like when you mentioned letters and Con
Ed,
we feel like we need to be the
magician.
But if you actually look at the research,
right,
I'm sure somebody smarter than me has it.
Doesn't it say it's the relationship?
And I mean, if they don't show up.
None of that con ed matters, does it?
Even if you have magic hands.
Yeah.
Same thing.
Like I've I've tried to look for the
research.
I've tried to look outside the profession.
I've tried to look at other data points
and I can't really put anything tangible
together to say, hey, look,
I'm proving it to you.
You're wrong and I'm right.
But I think on some level,
we have to acknowledge the fact that what
you said, if they're not there,
they're not going to get better.
If they don't like us, trust us,
want to be around us,
they're not going to get better.
And I think the thing that you said
is super important.
Like I've been married.
We're going on twenty years.
Dating.
before we got married.
I think you're cutting out a little bit,
Tony.
I think you were good there for a
hot minute,
but I think you're cutting out.
All right,
not sure if Tony can hear me.
If you got a question or a comment,
what I'll ask the audience,
because I think you could ask a hundred
different clinic owners in a hundred
different clinics what they think and feel
about this.
And it's in the name, right?
It's KPI, key performance indicators.
I think we use KPI so often.
Myself included, we'll just be like, wait,
what was it?
Key performance indicators.
How is this performing?
Performance to me feels like an outcome,
a result of.
So that's the whole thing with Goodhart's
Law is when the measure becomes the
target...
it fails to measure the thing that
matters.
That was the line in Larry Benz's article
that sort of hit.
I don't know if Tony is back.
There he is.
Yeah, he cut out there for a second.
But when you give someone a target,
they're going to game for the target.
But you can't... That's where it's like,
don't hate the player, hate the game,
but you just invented the game.
You're like... I'll give you an example.
In radio...
We were measured in quarter hours.
So if you were listening at twelve
fourteen,
if you wrote this is how this is
how accurate radio measurements were.
We they sent out thousands of diaries like
little books like that used to write
essays in high school, like little books.
And you're supposed to keep it with you
every day and write down what you were
listening to and when from twelve oh one
to twelve sixteen.
So radio is measured in quarter hours.
So if you wrote down someone wrote down
a listing at twelve fifteen and I stopped
at twelve thirty one.
How many minutes is that right?
That's three quarter hours.
because you were in the first quarter
hour, twelve fourteen,
you crossed and crossed twelve fifteen to
twelve sixteen.
That's the second quarter hour and you got
to thirty one.
So what did Jimmy do?
I made sure we were not in commercial
breaks during
The change over quarter hours.
I made sure we optimized our clocks or
when we played commercials or when we were
playing songs.
Did I try to game the system?
Absolutely.
Because if that's how you're going to
arbitrarily measure me, quality,
that's how I'm going to show up on
the field.
It's just also funny that the name of
the company that did radio ratings,
and I believe still does,
is called Arbitron.
Felt arbitrary to us.
We could kick ass all day, every day.
But if we got a few diaries that
people didn't listen to us,
or they just happened to not be listening
that ratings period,
but those were the KPIs.
TSL in radio.
Time spent listening.
Man, maybe that is a good...
Maybe that's a good KPI for...
Now that we can record with AI scribes
and technology, time spent listening.
You can measure.
Maybe I just invented a new KPI.
Time spent listening.
This would be an interesting one.
Once Tony gets back on,
I'll ask him about it.
But time spent listening would be
If you have a half hour,
a forty five or a sixty minute slot
with your patient,
how much time do you spend actually
listening?
That would be an interesting question and
an interesting KPI to think about.
I'd love to hear from the audience.
now or later on if you want to
jump on linkedin and just comment what are
the kpis that you have that you actually
track now keep in mind with ehrs now
today you can track a lot of them
maybe too well definitely too many because
they all the kpis can't be key so
which are the ones that matter and i'll
get into that once once tony gets back
on the uh the show
And the question is,
if you've ever improved a metric only to
see results actually go down.
So you put something on the scoreboard to
gamify in terms of a KPI, but results,
the product,
the big picture thing has actually gone
down.
And Tony talked about this last week.
He optimized for his front desk
For arrival rate,
someone gets put on the schedule a day,
a week, a month ahead.
How many actually arrive?
Sounds pretty good.
Arrival rate on the schedule.
How many actually show up a week,
a month, a quarter later?
How many?
And then Tony talked about, well, whoops,
if I'm being measured for arrival rate...
I'm probably not going to put questionable
people on the schedule.
And that makes sense.
You just taught your front desk what was
important.
Arrival rate, not helping people.
And that's a problem.
Tony, you still there?
So I would like to know what the
KPIs are for people out there.
that are actually key and actually move
the needle.
And we can get into that.
I do want to make sure we have
our sponsors taken care of.
So let's welcome in our newest sponsor,
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I mean, that plays right into,
I'm wondering if Tony's team did have
front desk crystal ball.
Let me see if I can get Tony.
Let's move to the next topic,
and then we'll come back to when Tony
either calls in or can get back online.
Next topic, content.
We said something last show that I felt
mattered.
I figured out how to do it wrong
a lot.
That's what I said last show.
That was on Tuesday.
Most PT content fails, in my opinion,
for one of a couple reasons,
but this is a key one.
I think it's made for the creator,
not the platform.
If you work for small organizations,
or you're a solo person,
is the content made for you?
Or is the content made for your CEO?
Tony's back in the, all right.
So hey, before we move on to content,
What are the KPIs that matter?
Let's not just bitch about something and
sort of poke.
I told everybody about how you had said
two days ago that when you optimize for
arrival or showing up arrival,
I put you on the schedule a day,
a week, a month out,
and then you show up.
Boom.
Keep that number as close to a hundred
percent.
And then you said your front desk figured
out what game they were playing and played
it well.
What happened with that?
Yeah,
so we eventually had to get to the
point where we realized that we always
were small.
At our biggest, we were at five locations.
So I could identify a single individual
who understood the intention behind the
KPI.
There you go.
Put that person in charge of the KPI
and they would perform in the way that
we wanted.
But if I just took a random person,
if I had a hundred front desk positions
and tried to expect them to perform the
way I wanted them to perform,
it was always
All right, Tony, can you hear me?
I can.
I don't understand what is going on for
us today.
Listen,
every once in a while the internet just
hates us,
but I'm pretty sure everybody can hear you
now, so keep going.
All right,
so you were saying if you had a
hundred people,
it sounds like you're starting the
explanation where it's like,
do you need to understand the letter of
the law or the spirit of the law?
Yeah, yeah, the intent behind it.
And so we got to the point where
we said, hey,
we've got all these
you know, twenty, thirty,
forty KPIs and we're feeling good about
tracking all these metrics and looking at
these charts and the charts are going up
and to the right and we realize it
doesn't matter.
What actually matters?
I need profit.
Are we making profit?
How are we measuring profit?
Am I making profit?
What actions can I take to make profit
go up?
What action can I take to make profit
go down?
Let's do more of one and less of
the other.
And we say, look,
I don't even care if it's profit from
physical therapy.
There's nothing that says I have to only
make profit from physical therapy.
Hence,
you see the major shift away from physical
therapy as a profit center to media as
a profit center.
Right.
I was watching...
It made me think of you.
Because first, they mock you.
uh i forget what the next step is
there's like a natural progression like
grief like first they mock you then they
whatever and then like by the end of
the step like they're like i i always
believed in you right like i'm not gonna
call them out but my classmates in pt
school when i launched this podcast we're
like this podcast dude talking to you
talking to yourself and now they're like i
always believed in you ten years later
like i i saw i saw the vision
too um
I saw a video or a series of
videos.
Have you seen this one?
It's essentially a remote control car with
a GoPro on it.
And you're seeing the point of view of
the car.
It's first person.
And the remote control car has a little
container on it filled with dog food.
And it drives around back alleys looking
for stray dogs.
And of course,
the videos are all pretty much the same.
First of all,
a dog is going to be like,
what the hell is this?
And be scared.
And then eventually it's going to sniff,
sniff, sniff,
and then it's going to eat the food.
And of course,
there's violin music playing in the
background.
And you watch it because the story is
about a dog who's hungry and now you're
feeding it.
It's similar to the idea of some guy
knocking on a door of this house that's
got just an overrun lawn.
And he starts talking to the owner.
Yeah.
right person's older and they can't afford
to do their lawn but the city is
going to come find them and of course
this guy mows their lawn so the cost
of the remote control car and the person's
time to make the video with the dog
and the person's you know time and the
the the gas and the tools to do
a lawn the video with the lawn that
i saw number one had a million likes
Yeah.
Nevermind views.
Like,
I don't even know how many views it
was.
It had a million likes.
So views are always going to outdo the,
the, the interactions.
And then by the end of the video,
he was like, and by the way,
we started to go fund me.
And if the video was telling the truth
and it, at this point, I'm not shocked.
They started to go fund me for this
woman.
Cause of course the guy then is getting
into her story.
My husband passed away.
My kids are dead.
I can't take care of my house.
And they raised a half a million dollars
for her in like, like,
And you're telling me what we do is
impactful and has so many stories that you
couldn't actually start to say,
I'm leveraging the attention that I can
get from my clinic,
the stories I can cultivate here.
At some point,
it's going to be more valuable.
Let me give you one more example.
And then I want to hear what your
thoughts are.
And then I'm going to bring up some
of these videos on the screen.
Yeah.
I was talking with some APTA state
chapters recently.
I'm sort of still on the stupid idea
that every one of them needs their own
YouTube channel and podcast.
None of them are going to do it
themselves because they're all busy.
Being a member or being a volunteer is
their second or third or fourth
responsibility, but they all want it.
They want the attention, right?
Because they all say, what do you want?
More engagement.
I'm like, well,
you need to give people something to
engage with.
And I say, I will come on board.
I will help you.
I don't want to host your podcast.
I want to executive produce your podcast.
I will turn your volunteers into podcast
hosts.
I will build the system and I will
make sure the system runs.
I will find sponsors in a state like
New York or Texas or California.
We'll just go to the top ten organizations
that want to hire PTs and PTAs and
go, hey,
I have a direct route of attention of
the people you want to hire.
You pay this amount of money and that
attention now is yours for the year.
I will do that before I ever start.
And if I don't reach what my minimum
is to start, I just won't start.
And then you owe me nothing.
Anyway, I'm still on that.
Here is their concern.
And I think it's valid now,
but not in the future.
A couple of the chapters concerns were we
have in-person events.
We have a one or two day conference
every year in our state.
And we have sponsors for that.
What we don't want to do is we
don't want those sponsors to be like,
well,
why would I pay two thousand dollars for
a table for a couple hours,
two days a year when I can have
eyes and ears of their attention three
hundred and sixty five days a year?
And my response is exactly right.
Right.
So right now I said, OK, well,
then only offer the YouTube and podcast
sponsorship to the people who already are
sponsoring your in-person event.
You have to be sponsoring the in-person
event.
Then you're allowed to be able to have
access to this.
My prediction, Tony, in the near future,
that will be flipped.
You are only allowed to come in person
if you are a sponsor of the digital
content because that will be the more
valuable thing, in my opinion,
because it will be in their inbox once,
twice a week.
It'll be in their feeds six,
seven times a week.
It'll be in their ears all the time.
Right.
I think this is going to happen.
So this just goes to your idea of
eventually there'll be a clinic...
that will make more money or provide free
care.
And the way they monetize and pay recoup
their costs and make money from this is
the attention that they derive from it.
I'm shocked we haven't seen more of it
outside of our profession in medicine.
Have you seen anybody in direct patient
care, like a GP doing anything like this?
Why wouldn't they?
No, I haven't seen it.
I mean,
we've seen GPs and orthopedics and other
people make huge media channels and
completely replace their income from
media,
but they've never really built a native
business model that said, hey,
we're going to give away the healthcare
for free in exchange for collecting the
profits on the media side.
It's like if I ever opened a restaurant,
imagine a restaurant that said,
we're going to give away the food for
free,
but we're going to charge you for the
seat, for the silverware,
and for the tablecloth.
Right, right, right, right, right.
It's just a change in mindset.
But I just think that we're still in
such a world where I'm going to school
to become a physical therapist.
Physical therapy is the most important
thing.
It's the most valuable thing.
How can you devalue the profession?
I mean,
I still hear those silly arguments of
you're devaluing the profession.
How could you do that?
Why would you give it away for free?
Um,
And this goes back to my problem with
people who don't understand business and
free markets and capitalism.
We should be innovating.
We should be changing and evolving and
improving.
We see so many businesses that come out
and serve a public customer
in ways that never happened before.
And everybody loves it.
And everybody's quality of life is better
until that company starts making too much
money.
And then all of a sudden,
everybody wants to tear it back down.
Correct.
We love winners.
Everybody loved the Yankees in the
eighties.
And then they started winning in the
nineties.
And everybody was like, these guys suck.
We couldn't buy a win in the eighties.
or a playoff spot.
And then they started winning and then
they suck.
Everybody loves you on the way up.
Did you see the movie air?
Did you see the Michael Jordan movie air?
Great movie.
You know, true story.
I'm using air quotes.
It's generally the true story,
but of course it's a movie.
So they got to sort of fictionalize it.
And Matt Damon,
essentially Michael Jordan,
was going to be the big draft pick.
He was going to go to the NBA.
And now it's like,
which company is going to get him for
the shoe deal?
Adidas, Converse, Reebok, whatever.
And Nike wasn't Nike yet.
Nike wasn't the Patriots yet.
They were still like this fifth best sort
of little step kid.
And Matt Damon delivers this speech to
Michael Jordan where he's like,
you'll do things that people have never
seen and they will love you for it.
And then eventually he's like,
and you'll reach the mountain.
You'll be the greatest ever.
And then all they'll want to do is
tear you down.
Yeah.
Everybody wants you to do well.
They just don't want you to do better
than them.
Right.
That's the problem.
They root for you until you're kicking
ass.
And they're like, he's sold out.
I knew that band before they were...
Cool.
It's an internal thing.
Here's the thing.
While you were talking,
I thought of one example in medicine and
one big example outside of medicine that
you actually brought up first that made me
say, wow.
One example in medicine of someone who I'm
betting not only gives away her medical
treatments for free,
I bet you they've paid to fly people
around the country to see her.
And I'm talking about Dr. Pimple Popper.
Cause she needs the most ridiculous cases.
Like she needs the,
somebody with the six pound lipoma on
their shoulder because that makes for some
content and whatever she's going to get
out of that video.
And I've got it on the screen.
I'll just click videos.
I won't even click popular yet.
I'll just click videos.
Three days ago, she released a video.
One hundred and ten thousand views.
Four days ago, eighty five.
Eight days ago, sixty seven.
If I were to click popular.
Oh, I can't.
There's popular.
What do you think her biggest videos that
have been around for ten years are getting
view wise?
Or the totals?
I'm going to say three million.
Seventy eight million.
So the video was released ten years ago.
This needs context.
How long has the video been around?
It's been around for ten years.
It's got seventy eight million views.
That doesn't tell the whole story, guys.
We're talking about KPIs.
It's still today, ten years later,
getting thirty five views per hour.
So like ballpark this for me because I'm
not really good with like CPM on YouTube.
What's a video getting thirty five views
per hour or a hundred views per hour?
What's that making her like?
What do you think she's walking away with?
There's an estimate because I use vid IQ.
So on the screen,
vid IQ is estimating the monthly revenue
for this YouTube channel.
It's a wide margin between ninety three
and two hundred and seventy eight thousand
dollars.
I know.
I know typical,
and it's going to depend on topic,
but if we put that video in the
lower revenue, lower CPM category,
it's going to be about,
I want to say it's like two thousand
dollars per million views.
So, you know,
you're looking at a hundred and forty
million dollars.
No, a hundred and forty thousand dollars.
For that one video.
For a seventy million view.
For that one video,
which is four minutes long.
Now, she had to find the patient.
And that's what happened right now.
I'm guessing in the beginning of Dr.
Pimple Popper's media career,
which I'm sure everybody took a dump on
him, which is like, this is stupid.
This is what you're going to do?
Videos?
Now she's a genius.
She was just serving people out of her
clinic and doing this as sort of like
a thing.
And then it hit a point where people
started going to her more than the people
down the street.
Why?
Because they saw her.
I got to know you and like you
a little bit.
Then if I trust you,
then you're my choice.
But then it probably hit a tipping point
where she's like,
even giving away this stuff for free,
we need more people.
Why?
Because we need more content because now
we're in the content business.
I mean, she's got...
I've been scrolling and I haven't found a
video yet that doesn't have multiple
millions of views.
And she's brilliant because each one of
these five, ten, fifteen minute videos,
then of course she cuts up into shorts
and
Do you even want to know what her
most popular shorts are looking at?
Ninety two million, fifty million,
twenty three million.
I mean, it's wild.
The other example,
do you remember the other example that you
gave me that sort of was like proof
of concept?
Do you remember what it was?
No.
Judge Judy.
People's court.
OK.
People come into court.
I'm suing this guy.
I'm suing my landlord.
But the whole model was the people,
the defendant and the defendant and the
what's the other?
I'm not in law school.
Plaintiff.
Thank you.
I'm sorry.
When we do a live stream,
I go blank.
Plaintiff.
None of whatever the judgment is,
it's binding,
but the show pays for the outcome.
So if I'm suing you for three thousand
dollars and I win,
you actually don't pay three thousand
dollars as the defendant.
Right.
The show does because the show is like
that nine minutes of whatever is
nine minutes of this.
We need more conversations because I need
nine minutes of attention because then
we're going to go to commercial break and
we're going to sell Corn Flakes and
Toyotas and MacBooks.
That's more valuable.
I don't remember who it was,
but somebody came out and said he and
his buddies would create fake claims.
They would file them.
They would get on the show.
They had gotten on the show at least
twice.
And it was completely made up,
but they knew how to game the system
to get on the show.
And now that person has some sort of
media outlet.
I know who it is.
And I can't remember his name.
He's the guy who creates fake Facebook
pages.
Yeah.
And then pokes the bear.
He'll create the IHOP...
The first one he did,
whatever city in California he lived in,
he created a Facebook page.
He's hysterical.
It's just the dumbest thing ever,
but he just does it over and over
and over again.
Yeah, that was the guy.
He just showed you, I can fake this.
Here's the thing.
Judge Judy doesn't care.
Right.
They're like, can you be...
entertaining can you captivate could you
create an interesting story for nine
minutes and this is where i look at
healthcare and i go you keep telling me
we're the most impactful this and we
change lives and i'm just saying stop
telling me and start showing me but don't
even show me show them well who's them
the other people you seek to serve
Now,
here's one of the reasons that people
won't do it.
Number one, the Roger Bannister effect.
No one's doing it.
So it's not possible because no one's
doing it.
That will go away as soon as someone
does it.
Then people will rush to fill the void.
And for people who don't know,
Roger Bannister was the first person to
break the four-minute mile.
And it was impossible.
And then he did it.
And then within the first eight months
after he did it,
Lots of people did it.
It fell.
So there's the Roger Bannister effect.
There's also, I think, the mismatched...
skill set effect, which is like,
I'm good at being a PT.
Now I have to learn how to do
media.
And I'll go, yes, you don't have to.
But if you want to do this,
you do.
Or you hire someone.
That's it.
You hire someone and you go all in.
I'm going to try this.
I'm going to do it for...
This isn't an overnight thing.
Dr. Pimplepot.
I would love to do it.
I would love to...
There's got to be a story on her.
I would love to hear where it started
and almost how I built this.
So many people crapped on me and they
told me this was stupid.
And now she sells subscriptions and she's
got this and people... She is... Oh,
I know who could do it.
I know who could do it in PT
tomorrow.
Stuart McGill.
Right?
Okay.
You know who Stuart McGill is?
Of course.
He could do it.
He's already before media.
I interviewed him when I was in PT
school a decade ago.
Yeah.
And he was telling me stuff that I
was like, oh my God, is this real?
I don't think he was lying.
People would fly to...
I believe he was in Nova Scotia.
They'd fly to Nova Scotia to be seen
by him.
And they'd stay for like a week and
get several treatments.
Why?
Because people talked about him.
They were like,
if you've been dealing with back pain for
ten years, you go to see Stuart McGill.
Love him or hate him, whatever.
That's not the point.
Don't get emotional about liking or not
liking Stuart McGill.
That's on you.
But like...
He did it before social media.
He did it, I don't know,
in message boards or whatever.
They found him and they flew there.
Yeah.
Yeah,
but this is just one leg of the
stool like you always talk about.
You and I tend to be media first
because that's our comfort zone.
This could be product sales.
This could be real estate.
This could be franchising.
This could be any number of things.
You look at the opportunity.
I would think physical therapists would be
the absolute best free market capitalists
in the world.
Why?
Because they are the best at analyzing a
problem and finding a solution.
And yet,
they refuse to look at this through any
unbiased point of view because
They forced it into,
it's like me having a bilateral amputee
and saying, nope, you got to walk.
Nope, no prosthetic.
You got to do it on your own.
No chance.
We're not doing anything different.
There's a thousand ways for that person to
locomote.
They don't need to do it the way
everybody else does it.
I don't understand why more of us don't
bring that into the business world and
just say, look,
I can bash my head against the wall
trying to force physical therapy to be
profitable in a CPT code model.
Right.
But why?
There's a million other ways to make the
profit I need to support the habit of
treating people.
The desire, the passion.
Yep.
The answer is always just Google emotion
wheel.
Have you ever seen the emotion wheel?
It looks like a color wheel.
So the emotion wheel...
I'll bring it up on the screen just
so I can talk about it well.
You'll find this in psychology classes.
And it's like a color wheel.
And you'll see around the edge.
Let me make sure I'm sharing it for
the nine people who are watching.
Yeah, I'm watching while you do that.
Perfect.
All right.
So here's the emotion wheel, right?
And if you go around the edge,
you see things like agony, hurt,
depressed, isolated, grief, power,
pleased, satisfied, amused, enchanted,
romantic, fond, frightened, helpless.
So it is a lot like color, right?
Like green is good.
But the problem is...
or what the emotion wheel exists to sort
of help funnel.
If you look at it in one little
slice of the pie, it's a funnel.
So let's just go to panic here in
the red.
What's underneath panic?
Well, I'm panicked.
Why?
And then it goes to terror.
And then everything funnels to fear.
So it's like if you're using any of
these words, it's because you mean this,
but you really mean fear.
You're not saying fear, but you mean fear.
So I sort of want to know what
is the feeling that stops healthcare
providers who, let's be honest,
and I'm speaking in generalities because I
have to,
but we want to prove our worth.
I want to show you, especially PTs, right?
Because we're like, we are doctors.
It's like you're coming at it from a
position of trying to prove yourself.
I can say this because I am one.
But I want to try to find the
right word on the color wheel or the
emotion wheel to
that actually talks about why shameful.
No, I don't think it's shameful.
Insecure.
There it is.
So the root, the, all right.
So I think the word is insecure.
Would you agree?
Like, why do we, yeah.
So I found, so above,
so here's how we follow the path inferior.
So if I feel inferior or inadequate,
both of those go to insecure,
insecure goes to fear.
And then we go to Yoda.
Fear is the path to the dark side,
right?
So because I want to make sure I
appear superior and not inferior,
I will do everything the way because I
am aware that everybody in the medical,
everybody in the world is looking at me
and I need to appear to do everything
the right way,
just like everybody else that I want to
appear on the level with.
So we might be the last group that
does this because we want to maintain this
last bastion of, I earned this,
which I agree, I did.
But stop telling people that are never
going to agree with you anyway.
If I waited for permission to start a
podcast, I'd still be waiting.
I did it because I liked it.
Like it was very selfish.
So I like to me,
you have to get to the emotion of
what's stopping you.
Right.
That's the whole point with the stealth.
Twelve step program is like you have to
admit.
Well,
before you have to before you make up
the problem,
you have to know what the problem is.
I think the answer is inferiority,
insecure fear.
If you follow that on the emotion wheel,
that is my view.
And I don't I'm not standing here saying
I'm smart enough to figure out why or
how we get over that.
But that's the thing we have to get
over.
It's not a technology thing.
Because even like a fun exercise that I'll
do after this,
and I'll post it on LinkedIn and Facebook,
it'll be a long text thread,
or maybe I'll make it a short video.
I'll go research Dr.
Pimple Popper and be like,
give me the beats.
Give me the timeline.
How did she get from where she is
now?
Where'd she start?
How did she twist and turn?
Right?
She probably got mocked, right?
And then run that parallel.
What does a PT need to do in
the next seven days,
PT now it's not going to be a
direct parallel because like I don't know
there's two types of people Tony do you
like Dr.
Pimple Popper's stuff does that like draw
you in I don't watch it no I'm
not a fan for some reason dude it
is like eye candy to me it's gross
yeah but I like gotta see it when
someone walks in with a giant hump on
their back I'm like what is in there
And I got to watch until this giant
chicken cutlet-sized thing comes out.
But there's enough people that are
repulsed by it, but even more people,
that many people watching it.
We don't necessarily have that.
We don't have directly that.
So the question would be,
what's our versions?
What are our versions of that?
Yeah, I wouldn't say we don't have that.
We do.
We do, just not that.
Obviously,
we've got lymphedema therapists.
We've got wound care therapists.
We've got therapists doing...
There's always something disgusting in the
clinic that's available.
For me, post-surgical incisions,
those are my biggest,
most popular Facebook posts.
But you could even go the direction of...
I shared a picture yesterday of a person.
I don't know this person.
They had a goniometer on their knee at
home.
It wasn't really lined up properly.
I knew it wasn't lined up properly.
I shared it.
And of course, most of the comments were,
they've got it in the wrong spot.
It's not lined up.
They don't know the anatomical landmarks,
you know?
Um, so like,
What you're really looking at is what is
inflammatory or exciting or disgusting or
whatever that doesn't cross the line but
will get eyeballs.
Dave shared an awesome video that we'll
talk about when he's back that's taking
off on Instagram.
I want to hear,
because I've been thinking about this
specifically for you.
You and I have had this conversation
before.
It's been a while.
I want to hear from you.
You just said,
I want to know her story.
Why aren't you the one that's contacting
her and saying, Hey,
I've got this podcast.
I'm in the PT space,
but I'm looking to expand outside.
I would love to get you on the
show and hear your background,
hear your story, hear your journey.
And for the last week or so,
For months,
you've been publishing a lot more.
You've got this goal of at least one
piece of content a day.
And I'm like, the thing for Jimmy... Yeah,
you're right.
Jimmy is fighting such an uphill battle
because how big is his potential audience
really?
How many therapists are there who actually
listen to a podcast about PT?
Narrow it down even more to business.
I'm like,
where Jimmy could turn a corner...
and be like, okay,
why don't I just broaden it out?
Maybe I make this more about professional
service-based businesses, not just PT.
What if I make this about small
businesses?
Yeah, because your concepts are universal.
The topics are universal.
This information, it is.
What we're talking about applies to every
professional and small business,
not just in healthcare.
Yeah.
You got me all feeling like, yeah,
I'm ready to run out of the room.
But do you want to know why I
haven't done it?
It's on the screen.
Yeah.
Fear.
It's fear.
Because I'm good in my...
I want to stay in my corner though.
It's funny that that line from Dirty
Dancing is like,
nobody puts baby in a corner.
But we wind up putting ourselves in a
corner.
Well, everybody... People should do this,
but not me.
You should do it.
You could do it.
You could pull it off.
I was talking with this woman.
Do you know Farley Schweigert?
Yeah, yeah.
She's over here.
If you've ever met Farley,
you don't even need to know who the
heck she is.
She comes on the screen and she's just
got a huge personality.
If I followed around with a camera every
day,
She'd spend more time smiling than not
smiling.
That's all I know about her.
And I'm like,
how are you having any problem getting
people to pay attention to videos?
Her personality is oozing through the Zoom
call that we were on.
And she was just like, well,
I don't feel like I...
And I'm able to spot it from a
mile away.
I'm like, oh, you need permission.
There's no such thing as permission,
but she feels like it.
So I keep on her ass.
I'm like,
have you done that thing we said?
And she's like, no.
Eventually she'll crack and she'll do it.
And then the only complaint that she'll
have is,
why didn't I do this six months ago
or six years ago?
And I'll go, I don't know,
but you're doing it now.
So let's triple down on that.
But you're right.
I should just go to Dr.
Pimple Popper and be like,
I should do a video where I go,
hey, everybody,
you should know who this is.
And then DM-er, not a piece of text,
I should DM-er a video of me in
one take looking in the camera and being
like,
I've been following your story for a long
time.
All I want to do is show PTs
what you've done or show healthcare what
you've done because I think the world
needs more people like you because you're
doing something very simple, not easy,
but simple and powerful.
I'm sure the American Dermatology
Association
hated her or people in it are like,
she is this and look how she does
that.
And they micromanage.
And then there's also a portion going,
hell yeah.
And I'm saying,
if you try to win everybody over,
you are not pizza, ice cream, or sex.
You can't do it.
You're not those three things.
You're not going to,
it's not going to happen.
So she didn't do that.
She didn't wait for permission.
She did it, but you're right.
I should,
I should find the dermatologist who,
find like that's how i should set this
up find the different specialties yeah you
got dr mike right dr got her you
got so many you can find them at
all different levels z dog and of course
then you go into like you should be
talking to the guy from the corner report
or corner or something oh yeah the guy
with all the small business ideas and
Just so many of those.
And like I said,
you and I have had this conversation.
We said,
who's going to be on the list?
Who are you going to reach out to?
I think you reached out to Seth Godin
at that time.
I reached out to a bunch.
And he politely declined.
Yeah, yeah.
That's okay.
Cost me nothing.
Yeah.
But if I knock on his door,
if I knock on his door,
I don't think he's doing this to me.
But if the fiftieth time, he's like, fine.
And then I give him such a ridiculously
good experience.
It's like the kid,
did you ever see the kid who's,
this is years ago,
started a Facebook channel,
which became a YouTube channel.
And he was like nine and he was
obsessed with like David Letterman and Jay
Leno.
Like he wanted to be a late night
host at like seven.
And this is years ago.
And then his mom or his dad was
just like, Ooh, like he's not stopping.
I need to shut this kid up.
So they started writing letters and
getting celebrities to come to their home
and sit on a couch.
And this nine-year-old kid,
I got to find out who that kid
was because it was great.
And he would do a late night show
and then he'd share it.
And then when the next time he went
to do a pitch, in the pitch,
he'd probably be,
and here's how we interviewed, blah, blah,
blah.
And someone's publicist was like,
this is like the Taylor Swift effect.
This doesn't make any sense.
Why would we take the star...
to do this ridiculously small kids thing
that's the reason like why does Taylor
Swift every once in a while show up
at a wedding and sing the first song
is because there's ninety seven camera
phones in the audience and it will blow
up because it's such a juxtaposition it
doesn't make any sense that it completely
all of a sudden being made she can't
do it every day but when she does
do it it's insane yeah
Fine.
Now I need to go do this.
I didn't think I needed to do the
things that I was saying, Tony.
I thought I just stood here and told
other people what they should be doing and
mocked them for not doing it.
Now I've mean, all right, fine.
I'll go.
I'll try.
I have no problem.
I'll fail.
Yeah.
Here's a KPI.
I mean,
that's your superpower is that you're
willing to experiment and try.
Hey, as we wrap up the show,
can you pull up my...
If you go to my Instagram on your
desktop,
go to the profile and show the recent
posts.
There's a KPI to measure as I'm bringing
this up,
which is how many times have you failed?
How many ideas have failed in the last
five months?
That would be a good one.
I can't even imagine.
I don't know how you keep track.
That's a good one.
Yeah.
All right.
I'm on your Instagram.
I have two days until spring.
Yeah.
Okay.
So if you look at that,
I want to give people something tangible
because we were talking about this in one
of the Facebook groups.
So a lot of these images,
some are actual photos.
Some are AI-generated images.
Obviously, the two days until spring.
That's an AI-generated image.
I made that yesterday when I realized I
saw somebody else's post and I was like,
oh, there's two days till spring.
Everybody loves to complain about winter.
I'm going to put up a post on
Facebook and Instagram.
So I go to ChatGPT.
I'm using the twenty dollar a month
account.
And I say, hey,
create a illustration in this case of,
you know,
a spring scene,
lots of flowers that are blooming,
put a total knee replacement prosthesis in
the middle of the scene,
a text overlay that says two days until
spring, generate that image.
And I mean, it's a decent image,
you know, it's nothing, nothing fancy.
If you look at the next one,
free coffee, same thing.
I was like, Oh,
I saw somebody standing on another post
next to an A-frame in front of a
coffee house.
Yep.
I was like, oh, that's a cool image.
Hey, ChessieBT,
create an A-frame image where in chalk,
you draw a total knee replacement
prosthesis.
You say across the top,
free coffee with a hundred and twenty
degrees of knee flexion.
I was trying to think of like how
I could tie in the temperature of the
coffee to the degrees of the knee,
but it was too complicated.
So I said, just do this.
Generated that a hundred and twelve likes,
twelve comments.
Yeah.
The big one, though, from yesterday,
do you see the one that has the
schematic of the knee replacement with the
nerves coming in from the medial side?
Wow, yeah, you're right.
So same thing.
I took that.
I did find a different illustration
online.
It was a black and white illustration,
line drawing.
I put that illustration into ChatGPT.
I said, use this as a reference image.
recreate this image with, I said,
text overlay, totally replacement,
you know, implant.
I want skin tone.
I want it to be a color image.
Show the incision.
This one image generated like a hundred
and thirty five thousand views.
It's got two hundred and ninety six parts
and two hundred and eighty four comments
in less than twenty four hours.
It's a lot.
That is a lot.
I'm going to the insights on my side.
Yeah.
And, you know, as I scroll down,
I mean, that's a ton of engagement.
So I posted thirteen or fourteen things
yesterday.
This was the winner.
But like, like talk about all you.
Can you see this video?
Can you talk about this video?
It's the one, no infection, just swelling.
It's like you poking at a knee
replacement.
Yeah,
so this was a person that had been
in my clinic multiple times,
had like six knee surgeries,
had a large implant put in.
I know this looks like an infected knee.
Literally,
this person came from the doctor before I
shot that video.
and confirm there's no infection.
But like the act of poking it,
this is what we're talking about with
simple pop.
Everybody goes crazy about this.
Every time I share this video,
it gets hundreds of thousands of views.
I've shared this video multiple times.
And I mean, it's just,
this is tugging at a certain emotional
thing in a person who's had a knee
replacement and they love it.
They love to comment and engage.
And this was one of my first videos
that jumped over a million views.
Yeah.
This one right now that I just brought
up is two point six.
But you've obviously shared it more than
once.
Right.
And why wouldn't you?
Yeah.
Yeah, of course.
Yeah.
Say it again.
And like this was a moment that could
have been lost in my physical therapy
clinic.
This video has probably generated a couple
hundred dollars in ad revenue across
YouTube and Facebook.
But like,
look at the hundred and forty three
thousand view video of the guy walking
with a cane on his right and I
circle the knee on the left.
Right.
That was a video that's been sitting on
my hard drive.
I didn't even know I had it sitting
on my hard drive since two thousand twenty
two.
I think this guy is still in my
clinic.
He's been coming for over ten years.
I pulled that video and showed it to
him yesterday when he came in.
I was like, hey,
I got to show you.
I found an old video.
But again,
these are valuable assets that are sitting
in the ether that we're not taking
advantage of.
We're not monetizing.
And all I had to do was just
scroll through my old videos and be like,
oh, I haven't posted this for a while.
The first step is you had to take
it.
And that sounds stupid,
but you have to capture it.
Yeah, you have to capture it.
All right, we'll talk more.
We all have bones glued to our hands.
There's nothing special.
This is not about technology or skill.
This is about fear, myself included.
This is about getting over it and doing
it poorly.
None of Tony's stuff,
if you go to his Instagram,
and I'll put it in the show notes,
none of the stuff is like, like,
you're just, this is reality show.
You're not,
you're not scripting this at all.
You might be like, Hey,
move your knee or do that.
Do that.
Like you might have like a sort of
a half a plan.
You have an outline in your head,
but you're not doing multiple cuts.
Like Tony's not walking around with a ring
light.
Like it's just not like these are fit.
Like I just counted that one video with
the,
on the pointing to the surgical side with
the K five seconds.
Yeah.
Five seconds has turned into,
and you can tell me later with the
statistic, how much watch time.
Cause you can look at that in the
insights.
how many days probably worth of watch time
of a hundred and forty five thousand views
times five seconds.
And I could do that math quick,
but I can't do that math quick.
So let's dig into a bunch of content
because I wanted to talk about Judy and
her cafe and her pancakes.
I want to talk about that.
I want to talk about Dave's rocket ship.
I want to talk about my Avengers rocket
ship from a month ago.
And how do I recapture that?
So we'll get into let's get let's do
a whole episode specific on content.
We'll pick three sort of verticals and
dive into them.
Or maybe my guess is we could talk
about this all day.
This might be a couple episodes deep.
Yeah.
All right.
So parting shot for today.
What do you got?
You know, there's value all around us.
I mean,
literally value comes out of thin air.
It's just a matter of
choosing what you're going to monetize,
how you're going to capture the value,
and then putting it out there for the
consumer.
Choose your heart.
Mine will be directed towards the
listener, but also to me, which is, okay,
whatever you're most afraid of,
whatever you want the most but aren't
doing,
understand that the answer is probably
fear.
And I'll bring my buddy who's a
psychologist on to prove me right.
And he'll do a little therapy session of
why that is.
Understand that that's the barrier.
The results that you're not getting are
hiding in the work that you're not doing.
And that's what we'll do.
So we'll talk content on Tuesday.
Dave will be back by then.
His little weird video that was off the
cuff will have already crossed fifty
thousand views.
And that video doesn't make any sense
until it makes perfect sense.
Tony, I'll see you on Tuesday.
See you, dude.
That's it.
We're out.
Boys, what the hell are you doing?
Follow Tony Maritano on YouTube at Total
Therapy Solution.
Find Dave Kittle at
conciergepainrelief.com and on YouTube at
The Dave Kittle Show.
And follow Jimmy McKay at PT Podcast on
YouTube, the socials,
and wherever you binge podcasts you
pretend are for CEUs.
And hey, just a reminder,
none of this was for advice.
This was for entertainment only.
Our lawyers say that counts.
Thanks, Keith.